Provider Demographics
NPI:1902865421
Name:FAROOQUI, ASIF HUSSAIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ASIF
Middle Name:HUSSAIN
Last Name:FAROOQUI
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 1:9222 INDIANAPOLIS BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2559
Mailing Address - Country:US
Mailing Address - Phone:219-301-5212
Mailing Address - Fax:
Practice Address - Street 1:9222 INDIANAPOLIS BLVD STE C
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2559
Practice Address - Country:US
Practice Address - Phone:219-301-5212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA36350207R00000X
IN01063801A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200907820Medicaid
IA0476721Medicaid
IN200907820Medicaid
IAI43631Medicare UPIN
IAI16251Medicare ID - Type Unspecified
IA0476721Medicaid
IN941050TTTMedicare PIN