Provider Demographics
NPI:1013968536
Name:FARUQI, TABASSUM (MD)
Entity Type:Individual
Prefix:MRS
First Name:TABASSUM
Middle Name:
Last Name:FARUQI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TABASSUM
Other - Middle Name:
Other - Last Name:AZIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1725 W HARRISON ST STE 837
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3866
Mailing Address - Country:US
Mailing Address - Phone:129-428-9003
Mailing Address - Fax:312-563-2466
Practice Address - Street 1:1725 W HARRISON ST STE 837
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3866
Practice Address - Country:US
Practice Address - Phone:129-428-9003
Practice Address - Fax:312-563-2466
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108479207R00000X
MI4301071252207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1103305732OtherBCBS/BCN PROVIDER ID
MI383267121OtherPHCS
MI7484181OtherAETNA
MI1000918OtherMCLAREN HEALTH ADVANTAGE
MI1000918OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI1013968536Medicaid
MI200000001184OtherPHP
MI383267121OtherPPOM
MI0M21440016OtherMEDICARE PLUS BLUE
MI1000918OtherMCLAREN HEALTH PLAN-MEDICAID
MI110205490OtherRAILROAD MEDICARE
MI383267121010OtherTRICARE
MI200000001184OtherPHP FAMILYCARE
MI1000918OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI0M21440016OtherMEDICARE PLUS BLUE