Healthcare Provider Details

I. General information

NPI: 1558771238
Provider Name (Legal Business Name): ADNAN FARUQI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PLANTATION ISLAND DR S STE 302A
ST AUGUSTINE FL
32080-3117
US

IV. Provider business mailing address

1301 PLANTATION ISLAND DR S STE 302A
SAINT AUGUSTINE FL
32080-3117
US

V. Phone/Fax

Practice location:
  • Phone: 312-646-0660
  • Fax:
Mailing address:
  • Phone: 904-461-9330
  • Fax: 904-461-9331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME140144
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number260520
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME140144
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME140144
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number1024959
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: