Provider Demographics
NPI:1578584553
Name:FAROOQ, FARHA (MD)
Entity Type:Individual
Prefix:
First Name:FARHA
Middle Name:
Last Name:FAROOQ
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 1:1030 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-2127
Mailing Address - Country:US
Mailing Address - Phone:901-523-8990
Mailing Address - Fax:901-261-4511
Practice Address - Street 1:7070 HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:TN
Practice Address - Zip Code:38060-3208
Practice Address - Country:US
Practice Address - Phone:901-465-9902
Practice Address - Fax:901-465-2110
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000036783207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD3872320Medicaid
TN3872320Medicare ID - Type Unspecified
SD3872320Medicaid