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NPI Code Detail

MEDICARE: JORDAN ABRAHAM FARHAT DO

MEDICARE: JORDAN ABRAHAM FARHAT DO
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
1390200000XStudent in an Organized Health Care Education/Training Program
22084N0400XNeurology Physician82397MN

General Provider Information

NPI Number : 1336880525
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN ABRAHAM FARHAT DO
Provider Business Mailing Address
First Line : 909 FULTON ST SE STE 318
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55455-4800
Country : US
Telephone Number : 612-626-6688
Fax Number : 612-676-5057
Provider Business Practice Location Address
First Line : 909 FULTON ST SE STE 318
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55455-4800
Country : US
Telephone Number : 612-626-6688
Fax Number : 612-676-5057
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2022
Last Update Date : 06/14/2026

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