Basic Information
| Provider Information | |||||||||
| NPI: | 1275831521 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAMAD | ||||||||
| FirstName: | FARES | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1860 PAYSPHERE CIR | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606742586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304692000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17495 LA GRANGE RD | ||||||||
| Address2: | |||||||||
| City: | TINLEY PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604877581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7082267000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2011 | ||||||||
| LastUpdateDate: | 04/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036135144 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | 036135144 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207RG0100X | 036135144 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.