Provider Demographics
NPI:1013180322
Name:MASRI, FATINA (MD)
Entity Type:Individual
Prefix:
First Name:FATINA
Middle Name:
Last Name:MASRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13530 MICHIGAN AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3575
Mailing Address - Country:US
Mailing Address - Phone:313-945-9800
Mailing Address - Fax:313-945-9184
Practice Address - Street 1:13530 MICHIGAN AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3574
Practice Address - Country:US
Practice Address - Phone:313-945-9800
Practice Address - Fax:313-945-9184
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301053444207U00000X
MIFM053444208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1013180322Medicaid
MI0808276302OtherBCBS IND
MI0808276302OtherBCBS IND
MIG97188Medicare UPIN