Provider Demographics
NPI:1821098534
Name:FAROOQI, MANZOOR S (MD)
Entity Type:Individual
Prefix:DR
First Name:MANZOOR
Middle Name:S
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:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-0938
Mailing Address - Country:US
Mailing Address - Phone:254-634-6999
Mailing Address - Fax:254-200-4090
Practice Address - Street 1:3004 S W S YOUNG DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-2023
Practice Address - Country:US
Practice Address - Phone:254-634-7337
Practice Address - Fax:254-634-2592
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0741208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX710884482OtherHUMANA/MILITARY-TRICARE
TX0038ACOtherBCBS OF TEXAS
TX092090201Medicaid
TX092090202OtherMCD EPSDT
TXG32263Medicare UPIN
TX092090201Medicaid