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General NPI Number Information
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NPI Number | 1265720932
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Entity Type | Organization
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Legal Business Name | KAMAL FAHIM, M.D., P.L.C.
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Dates
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Enumeration Date | 07/15/2011
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Last Update Date | 07/15/2011
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Provider Practice Location Address
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Address Line | 4190 24TH AVE STE 204
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City | FORT GRATIOT
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State | MI
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Zip | 48059-3884
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Country | US
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Telephone | 810-989-7702
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Fax | 810-989-7703
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Provider Business Mailing Address
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Address Line | 4190 24TH AVE STE 204
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City | FORT GRATIOT
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State | MI
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Zip | 48059-3884
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Country | US
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Telephone | 810-989-7702
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Fax | 810-989-7703
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | KAMAL FAHIM
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Credential | M.D.
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Telephone | 810-989-7702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 4301090236
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License Number State | MI
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