Provider Demographics
NPI:1083751085
Name:FARES, ABDELKADER HASSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDELKADER
Middle Name:HASSAN
Last Name:FARES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9925 DIX
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1593
Mailing Address - Country:US
Mailing Address - Phone:313-843-1973
Mailing Address - Fax:313-843-1961
Practice Address - Street 1:9925 DIX
Practice Address - Street 2:SUITE 105
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1593
Practice Address - Country:US
Practice Address - Phone:313-843-1973
Practice Address - Fax:313-843-1961
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301043357207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease