Healthcare Provider Details

I. General information

NPI: 1255427472
Provider Name (Legal Business Name): FARES FEHMI YASIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4634 GREENFIELD RD
DEARBORN MI
48126-2844
US

IV. Provider business mailing address

24418 MICHIGAN AVE
DEARBORN MI
48124-1837
US

V. Phone/Fax

Practice location:
  • Phone: 313-749-7650
  • Fax: 313-749-7651
Mailing address:
  • Phone: 313-427-8826
  • Fax: 313-427-8821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301087049
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: