Provider Demographics
NPI:1033476767
Name:DALALY, FERAH ADIL (MD)
Entity Type:Individual
Prefix:
First Name:FERAH
Middle Name:ADIL
Last Name:DALALY
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 1:17900 23 MILE RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-1161
Mailing Address - Country:US
Mailing Address - Phone:586-868-9800
Mailing Address - Fax:586-868-9801
Practice Address - Street 1:17900 23 MILE RD
Practice Address - Street 2:SUITE 303
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-1161
Practice Address - Country:US
Practice Address - Phone:586-868-9800
Practice Address - Fax:586-868-9801
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301100595207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E031610OtherBCBSM GROUP PIN
MI700E031610OtherBCBSM GROUP PIN