Healthcare Provider Details

I. General information

NPI: 1790021673
Provider Name (Legal Business Name): MONA FAKIH DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2012
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25150 FORD ROAD
DEARBORN HEIGHTS MI
48127
US

IV. Provider business mailing address

25150 FORD RD STE 200
DEARBORN HEIGHTS MI
48127-3115
US

V. Phone/Fax

Practice location:
  • Phone: 313-277-0400
  • Fax:
Mailing address:
  • Phone: 313-277-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MONA YOUSSEF FAKIH
Title or Position: DR./ PHYSICIAN
Credential: D.O.
Phone: 313-277-0400