Provider Demographics
NPI:1134888639
Name:FARESTUFAIL PLLC
Entity type:Organization
Organization Name:FARESTUFAIL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FAWAD
Authorized Official - Middle Name:ASLAM
Authorized Official - Last Name:TUFAIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-813-9483
Mailing Address - Street 1:4616 US HWY 75 STE 203
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4582
Mailing Address - Country:US
Mailing Address - Phone:972-813-9483
Mailing Address - Fax:
Practice Address - Street 1:4616 US HWY 75 STE 203
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4582
Practice Address - Country:US
Practice Address - Phone:972-813-9483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-12
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty