Provider Demographics
NPI:1669433280
Name:FAROOQ, MOHAMMAD (MSPA-C)
Entity type:Individual
Prefix:MR
First Name:MOHAMMAD
Middle Name:
Last Name:FAROOQ
Suffix:
Gender:M
Credentials:MSPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 EAST HIGHRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LOMABRD
Mailing Address - State:IL
Mailing Address - Zip Code:60148
Mailing Address - Country:US
Mailing Address - Phone:630-953-0830
Mailing Address - Fax:708-202-2386
Practice Address - Street 1:5TH AND ROOSELVET RD
Practice Address - Street 2:HINES VA HOSPITAL
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-202-4365
Practice Address - Fax:708-202-2386
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical