Provider Demographics
NPI:1992381479
Name:FARAH, GHASSAN JEAN
Entity Type:Individual
Prefix:
First Name:GHASSAN
Middle Name:JEAN
Last Name:FARAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 S WOLCOTT AVE RM E-270
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3748
Mailing Address - Country:US
Mailing Address - Phone:312-996-9858
Mailing Address - Fax:312-996-9025
Practice Address - Street 1:830 W DIVERSEY PKWY RM 300
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1454
Practice Address - Country:US
Practice Address - Phone:773-248-4150
Practice Address - Fax:773-248-4291
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program