Healthcare Provider Details

I. General information

NPI: 1477542579
Provider Name (Legal Business Name): RODOLFO D FARHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18915 W 12 MILE RD
LATHRUP VILLAGE MI
48076-2575
US

IV. Provider business mailing address

18915 W 12 MILE RD
LATHRUP VILLAGE MI
48076-2575
US

V. Phone/Fax

Practice location:
  • Phone: 248-655-4490
  • Fax: 248-655-4491
Mailing address:
  • Phone: 248-655-4490
  • Fax: 248-655-4491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301061075
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: