Provider Demographics
NPI:1306880141
Name:FARAH, HUMAM W (M D)
Entity type:Individual
Prefix:DR
First Name:HUMAM
Middle Name:W
Last Name:FARAH
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-6877
Mailing Address - Country:US
Mailing Address - Phone:573-231-3766
Mailing Address - Fax:573-231-3827
Practice Address - Street 1:100 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6877
Practice Address - Country:US
Practice Address - Phone:573-231-3766
Practice Address - Fax:573-231-3827
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111211207RC0200X, 207RS0012X, 207RP1001X
MOMO111211207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204659908Medicaid
833120OtherMEDICARE GROUP #
IL2613OtherMEDICARE GROUP #
MO137720046Medicare PIN
833120021Medicare PIN
MO204659908Medicaid
IL2613055Medicare PIN
MO000091666Medicare PIN