Provider Demographics
NPI:1205970431
Name:FAROOQ, SHIRAZ (MD)
Entity type:Individual
Prefix:DR
First Name:SHIRAZ
Middle Name:
Last Name:FAROOQ
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:PO BOX 4386
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33677-4386
Mailing Address - Country:US
Mailing Address - Phone:813-278-6430
Mailing Address - Fax:855-832-3509
Practice Address - Street 1:2313 W VIOLET ST STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1421
Practice Address - Country:US
Practice Address - Phone:813-278-6430
Practice Address - Fax:855-832-3509
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD195552086S0102X, 208C00000X, 208600000X
FLME108308208C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002743100Medicaid
FL149U4OtherBLUE CROSS
FLED215YMedicare PIN
ME002765501Medicare UPIN
ME002765502Medicare UPIN