Basic Information
| Provider Information | |||||||||
| NPI: | 1457406720 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAROOQI | ||||||||
| FirstName: | SHAHZAD | ||||||||
| MiddleName: | AHMED | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30700 TELEGRAPH RD STE 1645 | ||||||||
| Address2: | |||||||||
| City: | BINGHAM FARMS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480254525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482831100 | ||||||||
| FaxNumber: | 2482831103 | ||||||||
| Practice Location | |||||||||
| Address1: | 4050 E 12 MILE RD | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5862612266 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 09/28/2018 | ||||||||
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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 | 2084P0802X | 4301082851 | MI | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry | 2084P0804X | 4301082851 | MI | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | 2084P0800X | 4301082851 | MI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.