Provider Demographics
NPI:1720430002
Name:RAHMAN, FAIZ MOHAMMED (DMD)
Entity Type:Individual
Prefix:DR
First Name:FAIZ
Middle Name:MOHAMMED
Last Name:RAHMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 S STATE ST
Mailing Address - Street 2:APT. 901
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1524
Mailing Address - Country:US
Mailing Address - Phone:630-885-6414
Mailing Address - Fax:
Practice Address - Street 1:2030 S STATE ST
Practice Address - Street 2:APT. 901
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1524
Practice Address - Country:US
Practice Address - Phone:630-885-6414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190307991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice