Provider Demographics
NPI:1003926973
Name:HUSAYN, FAROOQ JAMEEL (MD)
Entity Type:Individual
Prefix:
First Name:FAROOQ
Middle Name:JAMEEL
Last Name:HUSAYN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FAROOQ
Other - Middle Name:JAMEEL
Other - Last Name:HUSSAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6214 SARATOGA BLVD BLDG 3 STE A
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414
Mailing Address - Country:US
Mailing Address - Phone:805-451-9928
Mailing Address - Fax:
Practice Address - Street 1:6214 SARATOGA BLVD BLDG 3 STE A
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414
Practice Address - Country:US
Practice Address - Phone:805-451-9928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS7242208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX430040201Medicaid
CA00A319100Medicaid
CAWA31910AMedicare PIN