Provider Demographics
NPI:1053351643
Name:AHMED, FAROOQ (MD)
Entity type:Individual
Prefix:
First Name:FAROOQ
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4562 HUNTING TRL
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-3535
Mailing Address - Country:US
Mailing Address - Phone:561-843-5285
Mailing Address - Fax:561-471-4934
Practice Address - Street 1:4562 HUNTING TRL
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-3535
Practice Address - Country:US
Practice Address - Phone:561-843-5285
Practice Address - Fax:561-471-4934
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069574207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28203BOtherMEDICARE ID
FL270898100Medicaid