MEDICARE: DR. FARIHA QAYUM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2004019699	MO

General Provider Information

NPI Number	:	1255426961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FARIHA QAYUM M.D.

Provider Business Mailing Address
First Line	:	3619 RICHARDSON SQUARE DR
Second Line	:
City	:	ARNOLD
State	:	MO
Zip	:	63010-6022
Country	:	US
Telephone Number	:	636-717-6700
Fax Number	:	636-464-6755

Provider Business Practice Location Address
First Line	:	3619 RICHARDSON SQUARE DR
Second Line	:
City	:	ARNOLD
State	:	MO
Zip	:	63010-6022
Country	:	US
Telephone Number	:	636-717-6700
Fax Number	:	636-464-6755

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	03/15/2017

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