Provider Demographics
NPI:1851386460
Name:BURHANI, NAFISA D (MD)
Entity Type:Individual
Prefix:
First Name:NAFISA
Middle Name:D
Last Name:BURHANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:NAFISA
Other - Middle Name:D
Other - Last Name:KHOKHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
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 1:2614 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435
Practice Address - Country:US
Practice Address - Phone:815-725-1355
Practice Address - Fax:815-725-9857
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089567207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL82399OtherMEDICARE INDIV ID# FOR GROUP 336140
ILL98070OtherMEDICARE INDIV ID# FOR GROUP 205474
IL036089567Medicaid
IL830004996OtherMEDICARE RR
IL205474Medicare PIN
IL830004996OtherMEDICARE RR
ILL98070OtherMEDICARE INDIV ID# FOR GROUP 205474