Provider Demographics
NPI:1083281786
Name:FATEH, JIBRAN (MD)
Entity Type:Individual
Prefix:
First Name:JIBRAN
Middle Name:
Last Name:FATEH
Suffix:
Gender:M
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:ACADEMIC INTERNAL MEDICINE
Mailing Address - Street 2:22250 PROVIDENCE DR., 3PMB SUITE #301
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4818
Mailing Address - Country:US
Mailing Address - Phone:248-849-3281
Mailing Address - Fax:248-849-5449
Practice Address - Street 1:ACADEMIC INTERNAL MEDICINE
Practice Address - Street 2:22250 PROVIDENCE DR., 3PMB SUITE #301
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4818
Practice Address - Country:US
Practice Address - Phone:248-849-3281
Practice Address - Fax:248-849-5449
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program