Provider Demographics
NPI:1134188287
Name:SAHEB, FARID (MD)
Entity type:Individual
Prefix:
First Name:FARID
Middle Name:
Last Name:SAHEB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 BRADFORD LN
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2322
Mailing Address - Country:US
Mailing Address - Phone:312-910-3588
Mailing Address - Fax:
Practice Address - Street 1:4900 N CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706-2916
Practice Address - Country:US
Practice Address - Phone:312-910-3588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046314207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036046314Medicaid
IL036046314OtherLICENSE #
IL01606335OtherBCBS PROVIDER #
IL036046314OtherLICENSE #
IL479392Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
IL110106959Medicare ID - Type UnspecifiedRR MEDICARE PROVIDER #