Provider Demographics
NPI:1750426540
Name:ISLAM, FAROZAN (DO)
Entity type:Individual
Prefix:
First Name:FAROZAN
Middle Name:
Last Name:ISLAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5970
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-5312
Mailing Address - Country:US
Mailing Address - Phone:630-424-9482
Mailing Address - Fax:630-424-4783
Practice Address - Street 1:2803 BUTTERFIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1165
Practice Address - Country:US
Practice Address - Phone:630-424-9204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361139032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry