Provider Demographics
NPI:1710986286
Name:FAROOQI, MISBAH I (MD)
Entity Type:Individual
Prefix:
First Name:MISBAH
Middle Name:I
Last Name:FAROOQI
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 1:20454 NE FINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32424-6012
Mailing Address - Country:US
Mailing Address - Phone:850-674-2221
Mailing Address - Fax:850-674-2221
Practice Address - Street 1:20454 NE FINLEY AVE
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424-6012
Practice Address - Country:US
Practice Address - Phone:850-674-2221
Practice Address - Fax:850-674-2221
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69137207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379214500Medicaid
FL28394Medicare ID - Type Unspecified
FLG22921Medicare UPIN