Provider Demographics
NPI:1326286550
Name:M. FAROOQUI MD INC
Entity Type:Organization
Organization Name:M. FAROOQUI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:S
Authorized Official - Last Name:FAROOQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-788-4513
Mailing Address - Street 1:5825 MIDDLE CREST DR
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4606
Mailing Address - Country:US
Mailing Address - Phone:818-788-4513
Mailing Address - Fax:818-788-4523
Practice Address - Street 1:5825 MIDDLE CREST DR
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4606
Practice Address - Country:US
Practice Address - Phone:818-788-4513
Practice Address - Fax:818-788-4523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97911207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A979110Medicaid
CA00A979110Medicaid