Healthcare Provider Details

I. General information

NPI: 1417065186
Provider Name (Legal Business Name): FARID T FATA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 STAR BATT DR SUITE 200
ROCHESTER HILLS MI
48309-3712
US

IV. Provider business mailing address

1901 STAR BATT DR SUITE 200
ROCHESTER HILLS MI
48309-3712
US

V. Phone/Fax

Practice location:
  • Phone: 248-844-5690
  • Fax: 248-844-5691
Mailing address:
  • Phone: 248-844-5690
  • Fax: 248-844-5691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberFF072629
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: