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General NPI Number Information
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NPI Number | 1871781534
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Entity Type | Organization
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Legal Business Name | FAROOK J KIDWAI MD PC
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1340 WASHINGTON ST
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City | WATERTOWN
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State | NY
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Zip | 13601-4541
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Country | US
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Telephone | 315-755-6099
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Fax |
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Provider Business Mailing Address
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Address Line | 1340 WASHINGTON ST
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City | WATERTOWN
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State | NY
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Zip | 13601-4541
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Country | US
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Telephone | 315-755-6099
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. FAROOK J KIDWAI
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Credential | M.D.
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Telephone | 315-755-6099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 140410168
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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