MEDICARE: DR. AYAD A. FARJO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	4301068609	MI
2	207W00000X	Ophthalmology Physician	45989-020	WI
3	207W00000X	Ophthalmology Physician	34089	IA
4	207WX0120X	Cornea and External Diseases Specialist Physician	45989-020	WI
5	207WX0120X	Cornea and External Diseases Specialist Physician	34089	IA
6	207WX0120X	Cornea and External Diseases Specialist Physician	4301068609	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	34089	OTHER	IA	PHYSICIAN LICENSE
3	4301068609	OTHER	MI	PHYSICIAN LICENSE
4	18-0-47-1724-1	OTHER	MI	BCBSM PIN#
5	45989-020	OTHER	WI	STATE LICENSE NUMBER
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	5315025069	OTHER	MI	CONTROLLED SUBSTNCE LCNSE

General Provider Information

NPI Number	:	1649273947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AYAD A. FARJO M.D.

Provider Business Mailing Address
First Line	:	2305 GENOA BUSINESS PARK DR
Second Line	:	SUITE 250
City	:	BRIGHTON
State	:	MI
Zip	:	48114-7004
Country	:	US
Telephone Number	:	810-494-2020
Fax Number	:	810-494-0127

Provider Business Practice Location Address
First Line	:	2305 GENOA BUSINESS PARK DR STE 250
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48114-7006
Country	:	US
Telephone Number	:	810-494-2020
Fax Number	:	810-494-0127

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	09/14/2023

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