MEDICARE: DR. MONA Y FAKIH D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	5101017198	MI

General Provider Information

NPI Number	:	1003013913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONA Y FAKIH D.O.

Provider Business Mailing Address
First Line	:	25150 FORD ROAD STE 200
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-4124
Country	:	US
Telephone Number	:	313-277-0400
Fax Number	:

Provider Business Practice Location Address
First Line	:	25150 FORD ROAD SUITE 200
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-4001
Country	:	US
Telephone Number	:	313-277-0400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	11/26/2013

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