MEDICARE: DEARBORN PED & ADOL MED CENTER II PLLC

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1265310338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEARBORN PED & ADOL MED CENTER II PLLC

Provider Business Mailing Address
First Line	:	2547 MONROE ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-3013
Country	:	US
Telephone Number	:	313-791-8300
Fax Number	:	313-791-8302

Provider Business Practice Location Address
First Line	:	2547 MONROE ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-3013
Country	:	US
Telephone Number	:	313-791-8300
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MOHAMED FAKIH
Credential	:	MD
Telephone Number	:	313-605-1111

Provider Enumeration Date	:	08/26/2025
Last Update Date	:	09/30/2025

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