Provider Demographics
NPI:1063404457
Name:AMBAREEN, FARRUKH (MD)
Entity type:Individual
Prefix:
First Name:FARRUKH
Middle Name:
Last Name:AMBAREEN
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 1:7109 NW 11TH PLACE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605
Mailing Address - Country:US
Mailing Address - Phone:352-331-2890
Mailing Address - Fax:352-331-2915
Practice Address - Street 1:7109 NW 11TH PL STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3141
Practice Address - Country:US
Practice Address - Phone:352-331-2890
Practice Address - Fax:352-331-2915
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074916207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1001400042OtherBCBSM
MI104473357Medicaid
MI104474917Medicaid
MI104473348Medicaid
MI700A460030OtherBCBSM - GROUP
MI700A460030OtherBCBSM - GROUP
MI1001400042OtherBCBSM