Healthcare Provider Details

I. General information

NPI: 1851656706
Provider Name (Legal Business Name): MUHAMMAD FAROOQ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 LACEY ST
CAPE GIRARDEAU MO
63701-5230
US

IV. Provider business mailing address

1521 BIRCHWOOD
CAPE GIRARDEAU MO
63701-2967
US

V. Phone/Fax

Practice location:
  • Phone: 573-331-6676
  • Fax:
Mailing address:
  • Phone: 405-370-3629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2019024489
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2019024489
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number29218
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: