Healthcare Provider Details

I. General information

NPI: 1316358773
Provider Name (Legal Business Name): FAISAL RIDHA AL-TIMIMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29201 TELEGRAPH RD STE 301
SOUTHFIELD MI
48034-7646
US

IV. Provider business mailing address

29201 TELEGRAPH RD STE 301
SOUTHFIELD MI
48034-7646
US

V. Phone/Fax

Practice location:
  • Phone: 248-356-1321
  • Fax: 248-864-8865
Mailing address:
  • Phone: 248-356-1321
  • Fax: 248-864-8865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301114254
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: