Provider Demographics
NPI:1609977107
Name:IKRAMUDDIN, FARHA SAYEED (MD)
Entity Type:Individual
Prefix:
First Name:FARHA
Middle Name:SAYEED
Last Name:IKRAMUDDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FARHA
Other - Middle Name:AW
Other - Last Name:SIDDIQUI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE ST SE MMC 297
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-6688
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:516 DELAWARE ST SE PWB FIRST FLOOR, CLINIC 1A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-6688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46761208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN132634OtherU CARE
MN702T3IKOtherBLUE CROSS BLUE SHIELD
B686OtherCHAMPUS
MN23-00008OtherMEDICA-PRIMARY
2307518OtherARAZ
MN986465200Medicaid
1043062OtherPREFERRED ONE
WI34802600Medicaid
MT0149006Medicaid
IA0599266Medicaid
MN23-00416OtherSTATE MEDICA CHOICE
HP49460OtherHEALTH PARTNERS
MN702T3IKOtherBLUE CROSS BLUE SHIELD
MN132634OtherU CARE