MEDICARE: IMAN FAKIH-ELMENINI M.D.

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	4301065945	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841242989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IMAN FAKIH-ELMENINI M.D.

Provider Business Mailing Address
First Line	:	25516 FORD RD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-3022
Country	:	US
Telephone Number	:	313-792-0000
Fax Number	:	313-359-9333

Provider Business Practice Location Address
First Line	:	25516 FORD RD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-3022
Country	:	US
Telephone Number	:	313-792-0000
Fax Number	:	313-359-9333

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	03/07/2011

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