Provider Demographics
NPI:1922186063
Name:QURESHI, FARHAN MUJTABA (MD)
Entity type:Individual
Prefix:MR
First Name:FARHAN
Middle Name:MUJTABA
Last Name:QURESHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 HEALTH CENTER PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6652
Mailing Address - Country:US
Mailing Address - Phone:405-694-4144
Mailing Address - Fax:405-577-6108
Practice Address - Street 1:1601 HEALTH CENTER PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099
Practice Address - Country:US
Practice Address - Phone:405-717-6952
Practice Address - Fax:405-350-9687
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20920207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100224560AMedicaid
400522438Medicare ID - Type Unspecified
OK100224560AMedicaid