Healthcare Provider Details

I. General information

NPI: 1083281786
Provider Name (Legal Business Name): JIBRAN FATEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E MEDICAL CENTER DR
ANN ARBOR MI
48109-5000
US

IV. Provider business mailing address

1500 E MEDICAL CENTER DR
ANN ARBOR MI
48109-5000
US

V. Phone/Fax

Practice location:
  • Phone: 734-489-3148
  • Fax:
Mailing address:
  • Phone: 734-489-3148
  • Fax: 734-489-3148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301510886
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: