Fareed Clinic, PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

FAREED CLINIC, PLLC

Practice address

3455 Plymouth Blvd Ste 202
Plymouth, MN 55447-1540

Phone

(952) 250-9931

NPI assigned

Oct 5, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mohammad Tariq Fareed, M.D.NPI 1598839250

Title

Physician Owner

Phone

(952) 250-9931

Specialties & licenses 1

Addresses

Other names 1

• Fareed Clinic, PLLC Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mohammad Tariq Fareed, M.D.

  • Family Medicine Physician
  • Plymouth, MN
  • NPI 1598839250
  Medicare reassignment NPD Authorized official
• Kavitha Malango, NP

  • Nurse Practitioner
  • Plymouth, MN
  • NPI 1285267922
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1664928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664928000000",
    "number": "1649995317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3455 PLYMOUTH BLVD STE 202",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554471540",
            "telephone_number": "952-250-9931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3455 PLYMOUTH BLVD STE 202",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554471540",
            "telephone_number": "952-250-9931"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Maple Grove Arbor lakes",
            "address_2": "11670 Fountains Drive, Suite # 200, Office # 279",
            "address_purpose": "LOCATION",
            "city": "Maple Grove",
            "state": "MN",
            "postal_code": "55369",
            "country_code": "US",
            "telephone_number": "763-657-1044",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FAREED CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-05",
        "last_updated": "2022-10-05",
        "certification_date": "2022-10-04",
        "status": "A",
        "authorized_official_last_name": "FAREED",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_middle_name": "TARIQ",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "952-250-9931",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fareed Clinic, PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nicole A Fairburn
• Fairview Pharmacy Services, LLC
• Family & Cosmetic Gentle Dentistry, LTD
• Family Wellness Chiropractic, PC
• Khalil Wadih Simon Farah, M.D.
• Mohammad Tariq Fareed, M.D.
• Ashley Farmer
• Michael Cloud Fasching, MD
• Jonathan Andrew Faust, M.D.
• Tayler Feigum

• Primary Care Clinic/Center in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Primary Care Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.