Provider Demographics
NPI:1689628976
Name:FARHOUD, INSHIRAH (NP)
Entity Type:Individual
Prefix:MS
First Name:INSHIRAH
Middle Name:
Last Name:FARHOUD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ENSHIRA
Other - Middle Name:
Other - Last Name:JABER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5433 W FOND DU LAC AVE
Mailing Address - Street 2:MIDTOWN PEDIATRICS
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1382
Mailing Address - Country:US
Mailing Address - Phone:414-277-8900
Mailing Address - Fax:414-266-8939
Practice Address - Street 1:5433 W FOND DU LAC AVE
Practice Address - Street 2:MIDTOWN PEDIATRICS
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1382
Practice Address - Country:US
Practice Address - Phone:414-277-8900
Practice Address - Fax:414-266-8939
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI115515363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
005006261LOtherHUMANA
WI1689628976Medicaid
WIK400133399Medicare PIN
Q26822Medicare UPIN
0083Q73601Medicare ID - Type Unspecified