Healthcare Provider Details

I. General information

NPI: 1558712596
Provider Name (Legal Business Name): AHSAN FAROOQ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2119 E SOUTH BLVD STE 200
MONTGOMERY AL
36116-2496
US

IV. Provider business mailing address

301 BROWN SPRINGS RD
MONTGOMERY AL
36117-7005
US

V. Phone/Fax

Practice location:
  • Phone: 334-613-7070
  • Fax: 334-613-7072
Mailing address:
  • Phone: 334-747-4159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD.41907
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: