MEDICARE: MICHAEL S FAKHRAEE MD

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	2082S0105X	Surgery of the Hand (Plastic Surgery) Physician	MD018776E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	400138	OTHER	PA	BLUE CROSS &BLUE SHIELD
2	0052487000	OTHER	PA	KEYSONE HEALTH PLAN EAST
3	400138	OTHER	PA	PERSONAL CHOICE
4	400138	OTHER	PA	FEDERAL BLUE CROSS

General Provider Information

NPI Number	:	1215973565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL S FAKHRAEE MD

Provider Business Mailing Address
First Line	:	7500 CENTRAL AVE
Second Line	:	SUITE 101
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-2431
Country	:	US
Telephone Number	:	215-728-8200
Fax Number	:	215-725-3209

Provider Business Practice Location Address
First Line	:	7500 CENTRAL AVE
Second Line	:	SUITE 101
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-2431
Country	:	US
Telephone Number	:	215-728-8200
Fax Number	:	215-725-3209

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	02/29/2008

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Directions to “ MICHAEL S FAKHRAEE MD” Practice Location

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