Provider Demographics
NPI:1417966425
Name:JAVAID, FARHAN
Entity Type:Individual
Prefix:
First Name:FARHAN
Middle Name:
Last Name:JAVAID
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7818
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:1406 W 5TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1688
Practice Address - Country:US
Practice Address - Phone:606-330-2377
Practice Address - Fax:606-330-2369
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42890207Q00000X
CO42609207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO28400313Medicaid
KY7100099090 (KOHMG)Medicaid
I13425Medicare UPIN
KYK114121 (KOHMG)Medicare PIN
CO061844Medicare Oscar/Certification