Healthcare Provider Details

I. General information

NPI: 1063036572
Provider Name (Legal Business Name): NICHOLAS FARRAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TRINITY HEALTH IHA MEDICAL GROUP ORTHOPEDICS GENOA 2305 GENOA BUSINESS PARK STE 120
BRIGHTON MI
48114
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DR SUITE J2000
ANN ARBOR MI
48105
US

V. Phone/Fax

Practice location:
  • Phone: 734-593-5700
  • Fax: 734-426-9024
Mailing address:
  • Phone: 216-445-6915
  • Fax: 216-445-3694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35.153707
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301518228
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35.153707
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: