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General NPI Number Information
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NPI Number | 1447887146
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Entity Type | Individual
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Provider Name | MAHA FAKHERDDINE MD
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Gender | Female
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 159 KERCHEVAL AVE
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City | GROSSE POINTE FARMS
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State | MI
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Zip | 48236-3610
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Country | US
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Telephone | 313-622-2001
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Fax |
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Provider Business Mailing Address
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Address Line | 1 FORD PL STE 3A
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City | DETROIT
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State | MI
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Zip | 48202-3450
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Country | US
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Telephone | 313-874-4806
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 328584-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 4301514079
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License Number State | MI
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