Healthcare Provider Details

I. General information

NPI: 1336965227
Provider Name (Legal Business Name): FURQAN S AL-TAMIMI MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37625 PEMBROKE AVE
LIVONIA MI
48152-1050
US

IV. Provider business mailing address

37625 PEMBROKE AVE
LIVONIA MI
48152-1050
US

V. Phone/Fax

Practice location:
  • Phone: 313-656-4052
  • Fax:
Mailing address:
  • Phone: 313-656-4052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6362010078
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: