Healthcare Provider Details

I. General information

NPI: 1487600474
Provider Name (Legal Business Name): MUNA K. FARJO,M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 10/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 PLYMOUTH RD SUITE # 101
ANN ARBOR MI
48105-3205
US

IV. Provider business mailing address

3001 PLYMOUTH RD SUITE # 101
ANN ARBOR MI
48105-3205
US

V. Phone/Fax

Practice location:
  • Phone: 734-668-4700
  • Fax:
Mailing address:
  • Phone: 734-668-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number4301037565
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number4301037565
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number3401037565
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number4301037565
License Number StateMI

VIII. Authorized Official

Name: DR. MUNA K. FARJO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 734-668-4700