| Fareed Clinic, Pllc | |
|
3455 Plymouth Blvd Ste 202 Plymouth MN 55447-1540 | |
| (952) 250-9931 | |
| Not Available |
| Full Name | Fareed Clinic, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3455 Plymouth Blvd Ste 202, Plymouth, Minnesota |
| Authorized Official Name and Position | Mohammad Tariq Fareed (PHYSICIAN OWNER) |
| Authorized Official Contact | 9522509931 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fareed Clinic, Pllc 3455 Plymouth Blvd Ste 202 Plymouth MN 55447-1540 Ph: (952) 250-9931 | Fareed Clinic, Pllc 3455 Plymouth Blvd Ste 202 Plymouth MN 55447-1540 Ph: (952) 250-9931 |
| NPI Number | 1649995317 |
|---|---|
| Provider Enumeration Date | 10/05/2022 |
| Last Update Date | 10/05/2022 |
| Medicare PECOS PAC ID | 0244603116 |
|---|---|
| Medicare Enrollment ID | O20230224001185 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649995317 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Mohammad T Fareed |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598839250 PECOS PAC ID: 5698700144 Enrollment ID: I20051004000088 |
| Provider Name | Kavitha Malango |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285267922 PECOS PAC ID: 4688004302 Enrollment ID: I20200421001852 |
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