Provider Demographics
NPI:1770671646
Name:SHARFAEI, SORAYA (MD)
Entity Type:Individual
Prefix:
First Name:SORAYA
Middle Name:
Last Name:SHARFAEI
Suffix:
Gender:F
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:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:16519 S ROUTE 59 STE D
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-2608
Practice Address - Country:US
Practice Address - Phone:219-365-8533
Practice Address - Fax:219-365-8610
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0.36.123722207R00000X
IN01068880A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036123722Medicaid
IN200998880Medicaid
IN000000722507OtherANTHEM TRADITIONAL
INM400049287Medicare PIN