Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036-116126 | IL |
N | 111NI0900X | Internist | 036-116126 | IL |
N | 207RH0003X | Hematology & Oncology | 01066282A | IN |
N | 207RH0003X | Hematology & Oncology | 4301095492 | MI |
Y | 207RX0202X | Medical Oncology | 01066282A | IN |
NPI | 1104082809 |
---|---|
Provider Name | Mohamed Farhat |
First Address | South Bend, IN 46601-2349 |
Second Address | Crown Point, IN 46307-3676 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2008 |
Last Update Date | 03/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1104082809 | (05) | MI |
200947020 | (05) | IN |
P00760538 | RR MEDICARE (01) | IN |