Healthcare Provider Details

I. General information

NPI: 1346419223
Provider Name (Legal Business Name): MICHIGAN HOME VISITING PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24418 MICHIGAN AVE
DEARBORN MI
48124-1837
US

IV. Provider business mailing address

24418 MICHIGAN AVE
DEARBORN MI
48124-1837
US

V. Phone/Fax

Practice location:
  • Phone: 313-427-8826
  • Fax: 313-427-8821
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 Number
License Number State

VIII. Authorized Official

Name: DR. FARES YASIN
Title or Position: CEO/PRESIDENT
Credential: M.D.
Phone: 734-421-0900