Healthcare Provider Details

I. General information

NPI: 1396709259
Provider Name (Legal Business Name): HANY YOUSSEF FARAG MEKHAEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2006
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 MAJESTIC
ROCHESTER HILLS MI
48306-3575
US

IV. Provider business mailing address

43200 DEQUINDRE RD STE 104
STERLING HTS MI
48314-1707
US

V. Phone/Fax

Practice location:
  • Phone: 810-794-7750
  • Fax: 844-269-7554
Mailing address:
  • Phone: 586-799-4350
  • Fax: 586-799-4279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4301080242
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301080242
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: