Provider Demographics
NPI:1760447205
Name:FARRUKH, KAMRAN (MD)
Entity Type:Individual
Prefix:
First Name:KAMRAN
Middle Name:
Last Name:FARRUKH
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 1:8048 ROSEMERE WAY
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4297
Mailing Address - Country:US
Mailing Address - Phone:423-478-1050
Mailing Address - Fax:423-478-1075
Practice Address - Street 1:1060 WILLIAM WAY NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4369
Practice Address - Country:US
Practice Address - Phone:423-478-1050
Practice Address - Fax:423-478-1075
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD29073207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3334715Medicaid
TN3334715Medicare ID - Type Unspecified
TN3334715Medicaid