Provider Demographics
NPI:1558717645
Name:ISHFAQ, MUHAMMAD FAWAD (MD)
Entity type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:FAWAD
Last Name:ISHFAQ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3001 QUAIL SPRINGS PKWY FL 5
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-2640
Mailing Address - Country:US
Mailing Address - Phone:405-949-3417
Mailing Address - Fax:405-552-5165
Practice Address - Street 1:3300 NW EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4418
Practice Address - Country:US
Practice Address - Phone:405-949-3417
Practice Address - Fax:405-552-5165
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN790292084V0102X
OK437612084V0102X
KY567492084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular NeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200096230Medicaid