Provider Demographics
NPI:1629053996
Name:BELAL, FAROUK M (MD)
Entity Type:Individual
Prefix:
First Name:FAROUK
Middle Name:M
Last Name:BELAL
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 1:1286 S LINDEN RD
Mailing Address - Street 2:STE A
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3457
Mailing Address - Country:US
Mailing Address - Phone:863-293-8336
Mailing Address - Fax:863-293-8532
Practice Address - Street 1:1286 S LINDEN RD
Practice Address - Street 2:STE A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3457
Practice Address - Country:US
Practice Address - Phone:863-294-5505
Practice Address - Fax:397-851-7502
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95505207RI0011X
IA34291207RI0011X, 207RC0000X
MI4301110049207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275590400Medicaid
IA1248948Medicaid
FL275590400Medicaid
IA1248948Medicaid
FLU8005XMedicare PIN
FL275590400Medicaid