Provider Demographics
NPI:1063729895
Name:KALIMULLAH, FAIYAAZ AHMAD (MD)
Entity type:Individual
Prefix:DR
First Name:FAIYAAZ
Middle Name:AHMAD
Last Name:KALIMULLAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:755 N WELLS ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-3520
Mailing Address - Country:US
Mailing Address - Phone:312-380-6747
Mailing Address - Fax:312-348-7229
Practice Address - Street 1:755 N WELLS ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-3520
Practice Address - Country:US
Practice Address - Phone:312-380-6747
Practice Address - Fax:312-348-7229
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036139965207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400349186Medicare PIN