Provider Demographics
NPI:1174529861
Name:TAUSIF, FARZANA N (MD)
Entity type:Individual
Prefix:
First Name:FARZANA
Middle Name:N
Last Name:TAUSIF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SEAGATE # 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:419-824-1100
Mailing Address - Fax:419-824-1771
Practice Address - Street 1:5300 HARROUN RD STE 304
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2146
Practice Address - Country:US
Practice Address - Phone:419-824-1100
Practice Address - Fax:419-824-1771
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35068088207Q00000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3171933OtherCIGNA
OH0226464Medicaid
MI1174529861Medicaid
OH5767102OtherAETNA
OH3171933OtherCIGNA
OH5767102OtherAETNA
OHTA7325371Medicare PIN