Healthcare Provider Details

I. General information

NPI: 1003437856
Provider Name (Legal Business Name): MOHAMED FAKIH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2547 MONROE ST
DEARBORN MI
48124-3013
US

IV. Provider business mailing address

2547 MONROE ST
DEARBORN MI
48124-3013
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-4195
  • Fax:
Mailing address:
  • Phone: 313-791-8300
  • Fax: 313-791-8302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301511338
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: