MEDICARE: DR. FARIS HANNOODI 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	4301508263	MI

General Provider Information

NPI Number	:	1922482181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FARIS HANNOODI M.D.

Provider Business Mailing Address
First Line	:	2300 HAGGERTY RD STE 2150
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-2192
Country	:	US
Telephone Number	:	248-926-6610
Fax Number	:	248-926-6611

Provider Business Practice Location Address
First Line	:	2300 HAGGERTY RD STE 2150
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-2192
Country	:	US
Telephone Number	:	248-926-6610
Fax Number	:	248-926-6611

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

Provider Enumeration Date	:	07/16/2015
Last Update Date	:	07/16/2024

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