Healthcare Provider Details

I. General information

NPI: 1225457336
Provider Name (Legal Business Name): IMRAN FAROOQI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 07/21/2024
Certification Date: 07/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 N SAN FRANCISCO ST STE F
FLAGSTAFF AZ
86001-3265
US

IV. Provider business mailing address

32569 ENGLISH TURN
AVON LAKE OH
44012-3326
US

V. Phone/Fax

Practice location:
  • Phone: 520-244-0089
  • Fax:
Mailing address:
  • Phone: 440-334-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberU0584
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number72002
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: