Healthcare Provider Details

I. General information

NPI: 1346832193
Provider Name (Legal Business Name): MY DOCTORS CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 09/06/2023
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4353 MAPLE ST
DEARBORN MI
48126-3535
US

IV. Provider business mailing address

13530 MICHIGAN AVE STE 300
DEARBORN MI
48126-3555
US

V. Phone/Fax

Practice location:
  • Phone: 313-908-0004
  • Fax: 313-908-7873
Mailing address:
  • Phone: 313-908-9004
  • Fax: 313-908-7873

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 Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAOUD A FARAJ
Title or Position: OWNER
Credential:
Phone: 313-908-9004