Healthcare Provider Details

I. General information

NPI: 1578304614
Provider Name (Legal Business Name): FARHAN FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3390 N STATE RD
DAVISON MI
48423-1154
US

IV. Provider business mailing address

3390 N STATE RD
DAVISON MI
48423-1154
US

V. Phone/Fax

Practice location:
  • Phone: 810-652-6333
  • Fax:
Mailing address:
  • Phone: 810-652-6333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. THAER JAMAL FARHAN
Title or Position: OWNER
Credential: D.O.
Phone: 810-652-6333