Provider Demographics
NPI:1548470974
Name:FAROOQI, RIZWANUDDIN MOHAMMED (MD)
Entity type:Individual
Prefix:DR
First Name:RIZWANUDDIN
Middle Name:MOHAMMED
Last Name:FAROOQI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1919 W SWANN AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2417
Mailing Address - Country:US
Mailing Address - Phone:813-254-8055
Mailing Address - Fax:813-443-8163
Practice Address - Street 1:1919 W SWANN AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2404
Practice Address - Country:US
Practice Address - Phone:813-254-8055
Practice Address - Fax:813-443-8163
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97351207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL281155300Medicaid
FLAT693YMedicare PIN