=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487855391
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MASRI CLINIC FOR LASER & COSMETIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13530 MICHIGAN AVE SUITE 150
-----------------------------------------------------
City | DEARBORN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-945-9800
-----------------------------------------------------
Fax | 313-945-9184
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13530 MICHIGAN AVE SUITE 150
-----------------------------------------------------
City | DEARBORN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-945-9800
-----------------------------------------------------
Fax | 313-945-9184
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | FATINA MASRI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 313-945-9800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 4301052487
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 4301053444
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------