Healthcare Provider Details

I. General information

NPI: 1780850974
Provider Name (Legal Business Name): SALAH FARES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27211 LAHSER RD STE # 200
SOUTHFIELD MI
48034-8469
US

IV. Provider business mailing address

1111 MEDICAL PLAZA DRIVE SUITE 250
THE WOODLANDS TX
77380-3477
US

V. Phone/Fax

Practice location:
  • Phone: 248-358-4982
  • Fax: 248-358-5125
Mailing address:
  • Phone: 281-296-8788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberQ3670
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: