Provider Demographics
NPI:1447934211
Name:RAFAT, AISHA FARHEEN
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:FARHEEN
Last Name:RAFAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 RIVER HILLS LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-5045
Mailing Address - Country:US
Mailing Address - Phone:708-543-0378
Mailing Address - Fax:
Practice Address - Street 1:2401 RIVER HILLS LN
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-5045
Practice Address - Country:US
Practice Address - Phone:708-543-0378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant