1346681707 NPI number — DR. SEYED H FAKHRAEE MD

Table of content: DR. SEYED H FAKHRAEE MD (NPI 1346681707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346681707 NPI number — DR. SEYED H FAKHRAEE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAKHRAEE
Provider First Name:
SEYED
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1346681707
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1690 BRIAR RIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANN ARBOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48108-9400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ALI SHARIATI AVE
Provider Second Line Business Practice Location Address:
MOFID CHILDREN'S HOSPITAL
Provider Business Practice Location Address City Name:
TEHRAN
Provider Business Practice Location Address State Name:
TEHRAN
Provider Business Practice Location Address Postal Code:
15468
Provider Business Practice Location Address Country Code:
IR
Provider Business Practice Location Address Telephone Number:
011982122251736
Provider Business Practice Location Address Fax Number:
011982122251736
Provider Enumeration Date:
07/15/2013

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: 208000000X , with the licence number:  4301050957 , 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)





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