MEDICARE: SHAIB OMAR FAROUQ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle	APHM56	CO
2	172A00000X	Driver	160810866	CO

General Provider Information

NPI Number	:	1083454227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAIB OMAR FAROUQ

Provider Business Mailing Address
First Line	:	1059 RACINE ST
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80011-6323
Country	:	US
Telephone Number	:	303-285-0250
Fax Number	:

Provider Business Practice Location Address
First Line	:	1525 DALLAS ST
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80010-2014
Country	:	US
Telephone Number	:	303-285-0250
Fax Number	:	303-285-0139

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2024
Last Update Date	:	05/27/2024

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Directions to “ SHAIB OMAR FAROUQ ” Practice Location

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