Basic Information
| Provider Information | |||||||||
| NPI: | 1013968536 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARUQI | ||||||||
| FirstName: | TABASSUM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | AZIZ | ||||||||
| OtherFirstName: | TABASSUM | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1540 LAKE LANSING RD | ||||||||
| Address2: | STE. 201 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489123756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179133900 | ||||||||
| FaxNumber: | 5179133901 | ||||||||
| Practice Location | |||||||||
| Address1: | 1540 LAKE LANSING RD | ||||||||
| Address2: | STE. 201 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489123756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179133900 | ||||||||
| FaxNumber: | 5179133901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 02/19/2010 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301071252 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1000918 | 01 | MI | MCLAREN HEALTH PLAN-COMMERCIAL | OTHER | 0M21440016 | 01 | MI | MEDICARE PLUS BLUE | OTHER | 7484181 | 01 | MI | AETNA | OTHER | 110205490 | 01 | MI | RAILROAD MEDICARE | OTHER | 1013968536 | 05 | MI | MEDICAID | 200000001184 | 01 | MI | PHP | OTHER | 200000001184 | 01 | MI | PHP FAMILYCARE | OTHER | 383267121 | 01 | MI | PHCS | OTHER | 1103305732 | 01 | MI | BCBS/BCN PROVIDER ID | OTHER | 383267121 | 01 | MI | PPOM | OTHER | 1000918 | 01 | MI | MCLAREN HEALTH ADVANTAGE | OTHER | 1000918 | 01 | MI | MCLAREN HEALTH PLAN-MEDICAID | OTHER | 383267121010 | 01 | MI | TRICARE | OTHER |