Healthcare Provider Details

I. General information

NPI: 1477547297
Provider Name (Legal Business Name): RAND ABDULNOUR-FARJO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAND ABDULNOUR

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22201 MOROSS RD
DETROIT MI
48236-2169
US

IV. Provider business mailing address

22201 MOROSS RD
DETROIT MI
48236-2169
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-3481
  • Fax: 313-343-7937
Mailing address:
  • Phone: 313-343-3481
  • Fax: 313-343-7937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number4301067785
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: