Provider Demographics
NPI:1083600183
Name:FAREED-FARRUKH, SAMEERA F (MD)
Entity Type:Individual
Prefix:
First Name:SAMEERA
Middle Name:F
Last Name:FAREED-FARRUKH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:175 S UNION BLVD STE 350
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3146
Practice Address - Country:US
Practice Address - Phone:719-633-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8201207P00000X, 207R00000X
WAMD00045691207R00000X
WY7760A207R00000X
CODR.0069803207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODR.0069803OtherSTATE MEDICAL LICENSE
NV8201OtherSTATE MEDICAL LICENSE
NV002017004Medicaid
WAMD00045691OtherSTATE MEDICAL LICENSE
NV8201OtherSTATE MEDICAL LICENSE
NV002017004Medicaid