Healthcare Provider Details

I. General information

NPI: 1609918119
Provider Name (Legal Business Name): FRESHTEH FARAHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 MEDICAL ARTS BLVD STE 200
ANDERSON IN
46011
US

IV. Provider business mailing address

10845 GRIFFITH PEAK DR # 2
LAS VEGAS NV
89135-1553
US

V. Phone/Fax

Practice location:
  • Phone: 765-298-5439
  • Fax: 765-298-4920
Mailing address:
  • Phone: 818-572-0889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01068742A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: