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General NPI Number Information
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NPI Number | 1184038200
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Entity Type | Organization
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Legal Business Name | MOBILE PHYSICIAN GROUP, PLLC
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Dates
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Enumeration Date | 06/17/2014
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Last Update Date | 08/22/2014
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Provider Practice Location Address
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Address Line | 22137 MICHIGAN AVE
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City | DEARBORN
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State | MI
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Zip | 48124-2204
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Country | US
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Telephone | 734-729-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 22137 MICHIGAN AVE
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City | DEARBORN
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State | MI
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Zip | 48124-2204
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALI H FAKIH
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Credential | D.O
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Telephone | 734-729-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901004300
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License Number State | MI
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