MEDICARE: ALIREZA FARROKHROO

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1366492514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALIREZA FARROKHROO

Provider Business Mailing Address
First Line	:	290519 SAMFORD UNIVERSITY
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35229-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	290519 SAMFORD UNIVERSITY
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35229-0001
Country	:	US
Telephone Number	:	205-999-5372
Fax Number	:

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	07/08/2007

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Directions to “ ALIREZA FARROKHROO ” Practice Location

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