Provider Demographics
NPI:1760645659
Name:BISHEHSARI, FARAZ (MD)
Entity Type:Individual
Prefix:
First Name:FARAZ
Middle Name:
Last Name:BISHEHSARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 W HARRISON ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3841
Mailing Address - Country:US
Mailing Address - Phone:312-942-5861
Mailing Address - Fax:312-563-3945
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE 207
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-942-5861
Practice Address - Fax:312-563-3945
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-127476207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology