MEDICARE: MIRNA FARHAT MD, PLC

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	207RH0003X	Hematology & Oncology Physician	4301089788	MI

General Provider Information

NPI Number	:	1033581434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRNA FARHAT MD, PLC

Provider Business Mailing Address
First Line	:	4589 WESTLAND ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-2834
Country	:	US
Telephone Number	:	313-600-6838
Fax Number	:

Provider Business Practice Location Address
First Line	:	1537 MONROE ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-2842
Country	:	US
Telephone Number	:	313-789-7189
Fax Number	:	313-789-7188

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	MIRNA FARHAT
Credential	:	MD
Telephone Number	:	313-600-6838

Provider Enumeration Date	:	10/24/2015
Last Update Date	:	12/17/2015

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