1285730531 NPI number — DR. AHMAD RAFEEK FARAH D.P.M.

Table of content: PIER T WELLS (NPI 1891352969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285730531 NPI number — DR. AHMAD RAFEEK FARAH D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARAH
Provider First Name:
AHMAD
Provider Middle Name:
RAFEEK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285730531
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2105 WEST ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRENTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48183
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-675-7777
Provider Business Mailing Address Fax Number:
734-675-7785

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2105 WEST ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRENTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48183
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-675-7777
Provider Business Practice Location Address Fax Number:
734-675-7785
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  5901002222 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P58180002 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1881852887 . This is a "GROUP NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 50136 . This is a "HEALTH PLAN OF MICHIGAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5901002222 . This is a "MICHIGAN STATE LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 9365124 . This is a "PPOM COFINITY" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4858218080 . This is a "BC PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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