Healthcare Provider Details

I. General information

NPI: 1639864473
Provider Name (Legal Business Name): YAMEENAH FARRUKH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 E SHERMAN BLVD STE 240
MUSKEGON MI
49444-1854
US

IV. Provider business mailing address

1560 E SHERMAN BLVD STE 240
MUSKEGON MI
49444-1854
US

V. Phone/Fax

Practice location:
  • Phone: 231-672-3883
  • Fax: 231-672-3973
Mailing address:
  • Phone: 231-672-3883
  • Fax: 231-672-3973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4351051231
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: