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General NPI Number Information
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NPI Number | 1821166737
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Entity Type | Organization
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Legal Business Name | FAITH PRIMARY CARE, PC
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 08/22/2019
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Provider Practice Location Address
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Address Line | 315 S WAYNE RD
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City | WESTLAND
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State | MI
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Zip | 48186-4301
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Country | US
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Telephone | 734-895-8396
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Fax | 734-895-8571
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Provider Business Mailing Address
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Address Line | 22341 WEST EIGHT MILE ROAD SUITE 121
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City | DETROIT
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State | MI
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Zip | 48219
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Country | US
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Telephone | 313-533-3720
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Fax | 313-533-3283
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MAHIR MATTI
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Credential | MD
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Telephone | 313-533-3720
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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 | 4301078766
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License Number State | MI
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