Provider Demographics
NPI:1811053069
Name:FARROKH-SIAR, LILI (MD)
Entity type:Individual
Prefix:
First Name:LILI
Middle Name:
Last Name:FARROKH-SIAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST
Mailing Address - Street 2:1500
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2927
Mailing Address - Country:US
Mailing Address - Phone:312-475-1000
Mailing Address - Fax:312-475-1006
Practice Address - Street 1:676 N SAINT CLAIR ST
Practice Address - Street 2:1500
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2927
Practice Address - Country:US
Practice Address - Phone:312-475-1000
Practice Address - Fax:312-475-1006
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108893207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108893Medicaid
IL036108893Medicaid