Fareesa Khan LLC

Primary specialty

Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianTaxonomy code 207VF0040X

License

112917 Issued in MO

Legal business name

FAREESA KHAN LLC

Practice address

10004 Kennerly Rd Ste 255a
Saint Louis, MO 63128-2184

Phone

(314) 270-9880

NPI assigned

Feb 1, 2013

Organization subpart

No

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

Authorized official

Name

Fareesa G Khan, MD

Title

Owner

Phone

(636) 675-3107

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1359676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594339200000",
    "number": "1780923490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 410085",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631410085",
            "telephone_number": "636-675-3107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10004 KENNERLY RD STE 255A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282184",
            "telephone_number": "314-270-9880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAREESA KHAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-01",
        "last_updated": "2020-07-10",
        "certification_date": "2020-07-10",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "FAREESA",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "636-675-3107",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207VF0040X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "MO",
            "license": "112917",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203820014",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Khashayar Farahnak
• Yumna Farajallah
• Jeffrey Brent Farb, PSYD.
• Nuri Bradford Farber, MD
• Muhammad Amber Fareed, BDS, MSC, PHD,FRACDS
• Michael Joseph Farel, LCSW
• Ruth Farel
• Lee Farhat, RN
• Rania Farhat, M.D.
• Pegah Farhood

• Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.