Provider Demographics
NPI:1528111341
Name:LODHI, FAUZIA W (MD)
Entity type:Individual
Prefix:MRS
First Name:FAUZIA
Middle Name:W
Last Name:LODHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FAUZIA
Other - Middle Name:
Other - Last Name:NADIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6374 N LINCOLN AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-1275
Mailing Address - Country:US
Mailing Address - Phone:773-588-7733
Mailing Address - Fax:773-588-7340
Practice Address - Street 1:6374 N LINCOLN AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-1275
Practice Address - Country:US
Practice Address - Phone:773-588-7733
Practice Address - Fax:773-588-7340
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085761207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085761OtherSTATE LICENSE
IL036085761Medicaid
IL036085761Medicaid