Provider Demographics
NPI:1982633707
Name:FARHAN, JAMAL D (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMAL
Middle Name:D
Last Name:FARHAN
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 1:1020 CHARTER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3584
Mailing Address - Country:US
Mailing Address - Phone:810-720-0368
Mailing Address - Fax:810-720-0371
Practice Address - Street 1:1020 CHARTER DR
Practice Address - Street 2:SUITE A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3584
Practice Address - Country:US
Practice Address - Phone:810-720-0368
Practice Address - Fax:810-720-0371
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010689892086S0102X, 174400000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3314472Medicaid
MI0B56029OtherBLUE SHIELD OF MI
MI3314472Medicaid
MI0B56029OtherBLUE SHIELD OF MI