Healthcare Provider Details

I. General information

NPI: 1881024602
Provider Name (Legal Business Name): FNM PAK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14530 W MCNICHOLS RD
DETROIT MI
48235-3904
US

IV. Provider business mailing address

14530 W MCNICHOLS RD
DETROIT MI
48235-3904
US

V. Phone/Fax

Practice location:
  • Phone: 313-863-5100
  • Fax:
Mailing address:
  • Phone: 313-863-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberF-142170
License Number StateMI

VIII. Authorized Official

Name: FURQAN AALAM
Title or Position: PRESIDENT OFFICER
Credential:
Phone: 313-863-5100