Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 036135955 | IL |
NPI | 1235365834 |
---|---|
Provider Name | Farheen Mirza |
First Address | Winfield, IL 60190-1295 |
Second Address | Winfield, IL 60190-1222 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2009 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
206147 | MEDICARE GROUP (01) | IL |
F400393155 | MEDICARE INDIVIDUAL (01) | IL |