Healthcare Provider Details

I. General information

NPI: 1871624031
Provider Name (Legal Business Name): MICHAEL S FAKHRAEE MD ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 CENTRAL AVE SUITE 101
PHILADELPHIA PA
19111-2430
US

IV. Provider business mailing address

7500 CENTRAL AVE SUITE 101
PHILADELPHIA PA
19111-2430
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-8200
  • Fax: 215-725-3209
Mailing address:
  • Phone: 215-728-8200
  • Fax: 215-725-3209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL S FAKHRAEE
Title or Position: PRESIDENT
Credential: MD
Phone: 215-728-8200