Provider Demographics
NPI:1295762151
Name:IRFAN, TARIQ B (MD)
Entity type:Individual
Prefix:
First Name:TARIQ
Middle Name:B
Last Name:IRFAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2400 N ORANGE BLOSSOM TRAIL
Mailing Address - Street 2:SUITE 204
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-2307
Mailing Address - Country:US
Mailing Address - Phone:407-944-3097
Mailing Address - Fax:407-944-3098
Practice Address - Street 1:2400 N ORANGE BLOSSOM TRAIL
Practice Address - Street 2:SUITE 204
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-2307
Practice Address - Country:US
Practice Address - Phone:407-944-3097
Practice Address - Fax:407-944-3098
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2013-07-31
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Provider Licenses
StateLicense IDTaxonomies
WI44361-0202084N0400X
FLME1014092084S0012X, 2084N0400X, 2084N0600X, 2084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G56182Medicare UPIN