Provider Demographics
NPI:1396714705
Name:ABUZZAHAB, FARUK SAID SR (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:FARUK
Middle Name:SAID
Last Name:ABUZZAHAB
Suffix:SR
Gender:M
Credentials:MD, PHD
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Mailing Address - Street 1:3601 PARK CENTER BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2531
Mailing Address - Country:US
Mailing Address - Phone:952-926-3364
Mailing Address - Fax:952-926-3369
Practice Address - Street 1:3601 PARK CENTER BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2531
Practice Address - Country:US
Practice Address - Phone:952-926-3364
Practice Address - Fax:952-926-3369
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2008-05-27
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Provider Licenses
StateLicense IDTaxonomies
MN170682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN260000176Medicaid
MN938573800Medicaid
MNB58524Medicare ID - Type Unspecified