Basic Information
| Provider Information | |||||||||
| NPI: | 1013076470 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARADYAN | ||||||||
| FirstName: | SAM | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 OKEECHOBEE BLVD | ||||||||
| Address2: | 14TH FLOOR | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334016349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618040200 | ||||||||
| FaxNumber: | 5618040222 | ||||||||
| Practice Location | |||||||||
| Address1: | 525 OKEECHOBEE BLVD | ||||||||
| Address2: | 14TH FLOOR | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334016349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618040200 | ||||||||
| FaxNumber: | 5618040222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 07/17/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 247648 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RP1001X | 109689 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.