Healthcare Provider Details

I. General information

NPI: 1851736169
Provider Name (Legal Business Name): FARAH AKHDAR D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 12/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22250 PROVIDENCE DR STE 500
SOUTHFIELD MI
48075-6213
US

IV. Provider business mailing address

22250 PROVIDENCE DR SUITE 500
SOUTHFIELD MI
48075-4825
US

V. Phone/Fax

Practice location:
  • Phone: 248-849-3441
  • Fax: 248-849-5389
Mailing address:
  • Phone: 248-849-3441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101020236
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: