MEDICARE: FARHAD FAROKHI 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
1	207R00000X	Internal Medicine Physician	02002585C	IN
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	036102947	IL
3	207RC0000X	Cardiovascular Disease Physician	036102947	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639153216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARHAD FAROKHI DO

Provider Business Mailing Address
First Line	:	444 ROXBURY RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-5059
Country	:	US
Telephone Number	:	815-398-3000
Fax Number	:	815-398-3041

Provider Business Practice Location Address
First Line	:	444 ROXBURY RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-5059
Country	:	US
Telephone Number	:	815-398-3000
Fax Number	:	815-398-3041

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

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	01/21/2015

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Directions to “ FARHAD FAROKHI DO” Practice Location

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