Healthcare Provider Details

I. General information

NPI: 1336880525
Provider Name (Legal Business Name): JORDAN ABRAHAM FARHAT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 FULTON ST SE STE 318
MINNEAPOLIS MN
55455-4800
US

IV. Provider business mailing address

909 FULTON ST SE STE 318
MINNEAPOLIS MN
55455-4800
US

V. Phone/Fax

Practice location:
  • Phone: 612-626-6688
  • Fax: 612-676-5057
Mailing address:
  • Phone: 612-626-6688
  • Fax: 612-676-5057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number82397
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: