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General NPI Number Information
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NPI Number | 1245839752
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Entity Type | Organization
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Legal Business Name | DAOUD FARAJ PC
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 01/19/2021
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Provider Practice Location Address
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Address Line | 13530 MICHIGAN AVE STE 300
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City | DEARBORN
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State | MI
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Zip | 48126-3555
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Country | US
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Telephone | 313-908-0004
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Fax | 313-908-7873
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Provider Business Mailing Address
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Address Line | 4524 KINGSTON ST
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48125-3240
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Country | US
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Telephone | 313-682-7770
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Fax |
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Authorized Official
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Title or Position | SOLE PROVIDER
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Name | DAOUD A FARAJ
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Credential |
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Telephone | 313-701-4340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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