Provider Demographics
NPI:1639399363
Name:PASHA, FARRUKH SIERE (MD)
Entity Type:Individual
Prefix:DR
First Name:FARRUKH
Middle Name:SIERE
Last Name:PASHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7080 N PORT WASHINGTON RD
Mailing Address - Street 2:RHEUMATIC DISEASE CENTER
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3879
Mailing Address - Country:US
Mailing Address - Phone:414-351-4009
Mailing Address - Fax:414-351-7060
Practice Address - Street 1:7080 N PORT WASHINGTON RD
Practice Address - Street 2:RHEUMATIC DISEASE CENTER
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-3879
Practice Address - Country:US
Practice Address - Phone:414-351-4009
Practice Address - Fax:414-351-7060
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36116572207R00000X
WI54391-20207RR0500X
MS20276207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine