Healthcare Provider Details

I. General information

NPI: 1437637451
Provider Name (Legal Business Name): FARHEEN SURTIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9055 SPRINGBROOK DR NW
COON RAPIDS MN
55433-5841
US

IV. Provider business mailing address

9055 SPRINGBROOK DR NW
COON RAPIDS MN
55433-5841
US

V. Phone/Fax

Practice location:
  • Phone: 763-780-9155
  • Fax: 763-780-9155
Mailing address:
  • Phone: 763-780-9155
  • Fax: 763-236-1066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number79818
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number79818
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number79818
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: