Provider Demographics
NPI:1063800142
Name:ASAAD, FAROUK B (MD)
Entity type:Individual
Prefix:
First Name:FAROUK
Middle Name:B
Last Name:ASAAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 AMBRIANCE DR
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0807
Mailing Address - Country:US
Mailing Address - Phone:630-654-9660
Mailing Address - Fax:
Practice Address - Street 1:705 AMBRIANCE DR
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-0807
Practice Address - Country:US
Practice Address - Phone:630-654-9660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-24
Last Update Date:2014-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036052107207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine