Healthcare Provider Details

I. General information

NPI: 1629988456
Provider Name (Legal Business Name): FATEHI MAZIN FATEHI MALAYSHEH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HURLEY PLZ
FLINT MI
48503-5902
US

IV. Provider business mailing address

6047 FOUNTAIN POINTE APT 12
GRAND BLANC MI
48439-7784
US

V. Phone/Fax

Practice location:
  • Phone: 810-262-9000
  • Fax:
Mailing address:
  • Phone: 810-427-9228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351055779
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: