Individual
IBAD UI-HAQ FAROOQUI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
402 E MAIN ST, FORT WAYNE, IN 46802-1910
(260) 425-2630
(260) 425-2631
Mailing address
402 E MAIN ST, FORT WAYNE, IN 46802-1910
(260) 425-2630
(260) 425-2631
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01076754A
IN
207Q00000X
Family Medicine Physician
4301103866
MI
390200000X
Student in an Organized Health Care Education/Training Program
4301103866
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201359760
—
IN
Enumeration date
07/09/2013
Last updated
09/28/2020
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