Provider Demographics
NPI:1013059534
Name:ANWAR, FARZEEN (PA-C)
Entity type:Individual
Prefix:
First Name:FARZEEN
Middle Name:
Last Name:ANWAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4066 BOULDER CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-5487
Mailing Address - Country:US
Mailing Address - Phone:630-215-5719
Mailing Address - Fax:
Practice Address - Street 1:511 DUNDEE AVE
Practice Address - Street 2:
Practice Address - City:EAST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-1642
Practice Address - Country:US
Practice Address - Phone:847-844-3274
Practice Address - Fax:847-844-3275
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-002632363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant