Provider Demographics
NPI:1366447377
Name:FAROOQ, AMJAD (MD)
Entity Type:Individual
Prefix:DR
First Name:AMJAD
Middle Name:
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 1:3900 SUNFOREST CT STE 240
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4481
Mailing Address - Country:US
Mailing Address - Phone:419-472-3126
Mailing Address - Fax:419-472-3437
Practice Address - Street 1:3900 SUNFOREST CT STE 240
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4481
Practice Address - Country:US
Practice Address - Phone:419-472-3126
Practice Address - Fax:473-472-3437
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-2519-F207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2438302Medicaid
OH2438302Medicaid
OHFA4118061Medicare ID - Type Unspecified