Provider Demographics
NPI:1093942393
Name:FAROOQ, IMRAN SIKANDER (MD)
Entity Type:Individual
Prefix:
First Name:IMRAN
Middle Name:SIKANDER
Last Name:FAROOQ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 N ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5506
Mailing Address - Country:US
Mailing Address - Phone:407-896-0054
Mailing Address - Fax:407-898-4463
Practice Address - Street 1:2320 N ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5506
Practice Address - Country:US
Practice Address - Phone:407-896-0054
Practice Address - Fax:407-898-4463
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME132467207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102767500Medicaid