=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104125756
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IBIN SINA CARDIOVASCULAR CENTER PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2011
-----------------------------------------------------
Last Update Date | 03/22/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2678 MELCOMBE CIR 104
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48084-3457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-529-3939
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2678 MELCOMBE CIR 104
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48084-3457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-529-3939
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. FARID ZAYED
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 313-529-3939
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | MD13398R
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------