MEDICARE: MARIAM FARAJ

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1942041116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAM FARAJ

Provider Business Mailing Address
First Line	:	31950 CAMBRIDGE ST
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48154-3187
Country	:	US
Telephone Number	:	313-408-5233
Fax Number	:

Provider Business Practice Location Address
First Line	:	6119 KINLOCH ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2987
Country	:	US
Telephone Number	:	313-670-5939
Fax Number	:

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

Provider Enumeration Date	:	06/03/2024
Last Update Date	:	06/03/2024

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