Provider Demographics
NPI:1780637611
Name:FAROOQUI, M SHUAIB (MD)
Entity Type:Individual
Prefix:DR
First Name:M SHUAIB
Middle Name:
Last Name:FAROOQUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1002 N CHURCH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1439
Mailing Address - Country:US
Mailing Address - Phone:336-274-6447
Mailing Address - Fax:336-419-0012
Practice Address - Street 1:1002 N CHURCH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1439
Practice Address - Country:US
Practice Address - Phone:336-274-6447
Practice Address - Fax:336-419-0012
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200100863208600000X, 2086S0120X
MI4301090987208600000X, 2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1192559OtherAETNA
NC183729OtherMEDCOST
NC8912805Medicaid
NC12805OtherBCBS NC
NC12805OtherBCBS NC
H47136Medicare UPIN