Provider Demographics
NPI:1790778447
Name:AFAQ, IRFAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:IRFAN
Middle Name:A
Last Name:AFAQ
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:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47131-0265
Mailing Address - Country:US
Mailing Address - Phone:502-265-0491
Mailing Address - Fax:502-222-8745
Practice Address - Street 1:2700 VISSING PARK RD
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-5989
Practice Address - Country:US
Practice Address - Phone:502-265-0491
Practice Address - Fax:502-222-8745
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY377052084P0800X
IN01057489A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30612022Medicaid
KYI00009Medicare UPIN
IN160780FFMedicare PIN
IN1060780Medicare PIN
KY00644001Medicare PIN
KY30612022Medicaid