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General NPI Number Information
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NPI Number | 1891119566
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Entity Type | Organization
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Legal Business Name | ABDELKADER H. FARES, M.D., P.C.
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Dates
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Enumeration Date | 02/14/2014
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Last Update Date | 02/14/2014
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Provider Practice Location Address
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Address Line | 9925 DIX SUITE 105
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City | DEARBORN
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State | MI
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Zip | 48120-1593
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Country | US
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Telephone | 313-843-1973
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Fax | 313-843-1961
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Provider Business Mailing Address
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Address Line | 9925 DIX
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City | DEARBORN
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State | MI
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Zip | 48120-1593
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Country | US
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Telephone | 313-843-1973
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Fax | 313-843-1961
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. ABDELKADER H FARES
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Credential | M.D
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Telephone | 313-843-1973
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | AF04301043357
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License Number State | MI
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