Healthcare Provider Details

I. General information

NPI: 1467530428
Provider Name (Legal Business Name): FARIS PETER ATCHOO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4511 HIGHLAND RD
WATERFORD MI
48328-1132
US

IV. Provider business mailing address

4511 HIGHLAND RD
WATERFORD MI
48328-1132
US

V. Phone/Fax

Practice location:
  • Phone: 248-383-8172
  • Fax: 248-599-3963
Mailing address:
  • Phone: 248-383-8172
  • Fax: 248-599-3963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101011418
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: