Healthcare Provider Details

I. General information

NPI: 1497800767
Provider Name (Legal Business Name): FADI DAOUK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 VAILWOOD CT
BLOOMFIELD HILLS MI
48302-1573
US

IV. Provider business mailing address

318 VAILWOOD CT
BLOOMFIELD HILLS MI
48302-1573
US

V. Phone/Fax

Practice location:
  • Phone: 248-745-0809
  • Fax: 248-745-0809
Mailing address:
  • Phone: 248-745-0809
  • Fax: 248-745-0809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301058601
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: