Provider Demographics
NPI:1043851710
Name:FARAD, TIMOTHY SADDIQ
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:SADDIQ
Last Name:FARAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 VALENTIA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-2130
Mailing Address - Country:US
Mailing Address - Phone:720-621-0327
Mailing Address - Fax:
Practice Address - Street 1:1761 N OGDEN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1017
Practice Address - Country:US
Practice Address - Phone:720-432-7634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002492171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist