Healthcare Provider Details

I. General information

NPI: 1568184570
Provider Name (Legal Business Name): FAITH INTERNAL MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15645 FARMINGTON RD STE A
LIVONIA MI
48154-2851
US

IV. Provider business mailing address

15645 FARMINGTON RD STE A
LIVONIA MI
48154-2851
US

V. Phone/Fax

Practice location:
  • Phone: 734-464-7600
  • Fax: 734-464-9797
Mailing address:
  • Phone: 734-464-7600
  • Fax: 734-464-9797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LAITH JACOB
Title or Position: OWNER
Credential: MD, MBCHB
Phone: 248-245-6533