Healthcare Provider Details

I. General information

NPI: 1811021769
Provider Name (Legal Business Name): AHMED OMER FAROOQ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 PALERMO PL
VENICE FL
34285-2821
US

IV. Provider business mailing address

219 PALERMO PL
VENICE FL
34285-2821
US

V. Phone/Fax

Practice location:
  • Phone: 941-244-9524
  • Fax: 941-244-9526
Mailing address:
  • Phone: 941-244-9524
  • Fax: 941-244-9526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number2005-00638
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME 91511
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: