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General NPI Number Information
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NPI Number | 1174918684
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Entity Type | Organization
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Legal Business Name | FADI YASIN MD PLLC
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Dates
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Enumeration Date | 04/01/2015
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Last Update Date | 04/01/2015
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Provider Practice Location Address
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Address Line | 47166 MICHIGAN AVE
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City | CANTON
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State | MI
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Zip | 48188-2583
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Country | US
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Telephone | 734-495-9460
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Fax | 734-495-9461
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Provider Business Mailing Address
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Address Line | 47166 MICHIGAN AVE
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City | CANTON
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State | MI
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Zip | 48188-2583
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Country | US
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Telephone | 734-495-9460
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Fax | 734-495-9461
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Authorized Official
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Title or Position | MD/OWNER
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Name | FADI ABU YASIN
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Credential | MD
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Telephone | 734-495-9460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301085478
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License Number State | MI
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