MEDICARE: FARAH UBAID 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	207R00000X	Internal Medicine Physician	4301073757	MI
2	207P00000X	Emergency Medicine Physician	4301073757	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4301073757	OTHER	MI	PHYSICIAN LICENSE

General Provider Information

NPI Number	:	1235242272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARAH UBAID MD

Provider Business Mailing Address
First Line	:	18101 OAKWOOD BLVD
Second Line	:	EMERGENCY MEDICINE DEPARTMENT
City	:	DEARBORN
State	:	MI
Zip	:	48124-4089
Country	:	US
Telephone Number	:	313-593-8780
Fax Number	:	313-436-2864

Provider Business Practice Location Address
First Line	:	38935 ANN ARBOR RD
Second Line	:	CREDENTIALING/PAYER CONTRACTING
City	:	LIVONIA
State	:	MI
Zip	:	48150-3397
Country	:	US
Telephone Number	:	734-805-0477
Fax Number	:	866-250-6385

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	05/18/2010

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