Provider Demographics
NPI:1265713572
Name:SHAISTA H. FARUQUI, M.D. APMC
Entity type:Organization
Organization Name:SHAISTA H. FARUQUI, M.D. APMC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:REGINA
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-769-2161
Mailing Address - Street 1:5320 DIJON DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4313
Mailing Address - Country:US
Mailing Address - Phone:225-769-2161
Mailing Address - Fax:225-769-2166
Practice Address - Street 1:5320 DIJON DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4313
Practice Address - Country:US
Practice Address - Phone:225-769-2161
Practice Address - Fax:225-769-2166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1300004Medicaid
LA1300004Medicaid