Healthcare Provider Details

I. General information

NPI: 1083883953
Provider Name (Legal Business Name): DETROIT VISITING PHYSICIANS THERAPEUTICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16985 FARMINGTON RD
LIVONIA MI
48154-2946
US

IV. Provider business mailing address

16985 FARMINGTON RD
LIVONIA MI
48154-2946
US

V. Phone/Fax

Practice location:
  • Phone: 734-421-0900
  • Fax: 734-421-0700
Mailing address:
  • Phone: 734-421-0900
  • Fax: 734-421-0700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number4301087049
License Number StateMI

VIII. Authorized Official

Name: DR. FARES YASIN
Title or Position: CEO/PRESIDENT
Credential: M.D.
Phone: 734-421-0900