Healthcare Provider Details

I. General information

NPI: 1568997062
Provider Name (Legal Business Name): FIRAS MOHAMMED EL-BABA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2017
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST # 5C
DETROIT MI
48201-2153
US

IV. Provider business mailing address

2516 SEQUOIA CT
BLOOMFIELD HILLS MI
48304-1835
US

V. Phone/Fax

Practice location:
  • Phone: 248-953-0796
  • Fax:
Mailing address:
  • Phone: 248-953-0796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number4301518438
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD219789
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35.154022
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number4301518438
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD219789
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: