Provider Demographics
NPI:1265613087
Name:UDDIN, FARHANA F (PA)
Entity type:Individual
Prefix:
First Name:FARHANA
Middle Name:F
Last Name:UDDIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 CHESWICK DR
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5601
Mailing Address - Country:US
Mailing Address - Phone:847-708-8100
Mailing Address - Fax:
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:312-864-5233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085001218363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL001619727OtherBCBS OF ILLINOIS
IL212223OtherMEDICARE GROUP
ILDE0395OtherRAILROAD MEDICARE GROUP
IL212223OtherMEDICARE GROUP
ILDE0395OtherRAILROAD MEDICARE GROUP
IL5514060015Medicare NSC
ILK52194Medicare PIN
IL5514060005Medicare NSC
IL5514060003Medicare NSC