Provider Demographics
NPI:1609918119
Name:FARAHAN, FRESHTEH (MD)
Entity type:Individual
Prefix:DR
First Name:FRESHTEH
Middle Name:
Last Name:FARAHAN
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 1:10845 GRIFFITH PEAK DR # 2
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1553
Mailing Address - Country:US
Mailing Address - Phone:818-572-0889
Mailing Address - Fax:
Practice Address - Street 1:1629 MEDICAL ARTS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011
Practice Address - Country:US
Practice Address - Phone:765-298-5439
Practice Address - Fax:765-298-4920
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068742A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics