Provider Demographics
NPI:1104856145
Name:FAYZ, FRANK M (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:M
Last Name:FAYZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5470 WESSEX CT
Mailing Address - Street 2:APT 210
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-4270
Mailing Address - Country:US
Mailing Address - Phone:313-680-2173
Mailing Address - Fax:313-584-3000
Practice Address - Street 1:5470 WESSEX CT
Practice Address - Street 2:APT 210
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4270
Practice Address - Country:US
Practice Address - Phone:313-680-2173
Practice Address - Fax:313-584-3000
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME1172582085R0202X
MI43010560382085R0202X
GA0690452085R0202X
IN01071636A2085R0202X
PAMD045429E2085R0202X
OH35-0588532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1104856145Medicaid
OH0077969Medicaid
MI455491849050OtherCARESOURCE
OH455491849-00OtherOHIO BUREAU OF WORKERS'S COMPENSATION
MIDT3177OtherRAILROAD MEDICARE PALMETTO GBA
MI1104856145Medicaid
OH0077969Medicaid