Provider Demographics
NPI:1033581434
Name:MIRNA FARHAT MD, PLC
Entity Type:Organization
Organization Name:MIRNA FARHAT MD, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MIRNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARHAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-600-6838
Mailing Address - Street 1:4589 WESTLAND ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2834
Mailing Address - Country:US
Mailing Address - Phone:313-600-6838
Mailing Address - Fax:
Practice Address - Street 1:1537 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2842
Practice Address - Country:US
Practice Address - Phone:313-789-7189
Practice Address - Fax:313-789-7188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-24
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089788207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty