Provider Demographics
NPI:1023051265
Name:ASSOUAD, FARID
Entity type:Individual
Prefix:
First Name:FARID
Middle Name:
Last Name:ASSOUAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 GLADES RD
Mailing Address - Street 2:STE 100
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4150
Mailing Address - Country:US
Mailing Address - Phone:561-573-3495
Mailing Address - Fax:888-910-3040
Practice Address - Street 1:7777 GLADES RD
Practice Address - Street 2:STE 100
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4150
Practice Address - Country:US
Practice Address - Phone:561-573-3495
Practice Address - Fax:888-910-3040
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079607207R00000X, 207RG0300X
FLME98413207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4803597Medicaid
MI4803603Medicaid
MI1019481OtherMCLAREN HEALTH PLAN
FL278681800Medicaid
MI4948825-10Medicaid
MI1020018OtherMCLAREN HEALTH PLAN
MI110591010OtherBCBSM
MI110591010OtherBCBSM
MI1019481OtherMCLAREN HEALTH PLAN
FL278681800Medicaid