Healthcare Provider Details

I. General information

NPI: 1407549801
Provider Name (Legal Business Name): WALEED FARUQI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 E DIVISION ST
MOUNT VERNON WA
98274-4134
US

IV. Provider business mailing address

PO BOX 843324
LOS ANGELES CA
90084-3324
US

V. Phone/Fax

Practice location:
  • Phone: 360-424-0002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPODI.PO.70099278
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPODI.PO.70099278
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: