Provider Demographics
NPI:1114968419
Name:ATTAR, FAKHRUDDIN (MD)
Entity Type:Individual
Prefix:DR
First Name:FAKHRUDDIN
Middle Name:
Last Name:ATTAR
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 1:29247 SUMMERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3056
Mailing Address - Country:US
Mailing Address - Phone:734-427-9200
Mailing Address - Fax:734-427-9205
Practice Address - Street 1:32910 W 13 MILE RD STE A101
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1981
Practice Address - Country:US
Practice Address - Phone:734-427-9200
Practice Address - Fax:734-437-9094
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067384207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
383584824OtherIRS
MI4455214Medicaid
MI132633OtherCARECHOICES
110246543OtherRAILROAD MEDICARE
MIDR31588OtherMCARE
MI1106339271OtherBLUE CROSS BLUE SHEILD MI
MI1106339271OtherBLUE CROSS BLUE SHEILD MI
0N61940Medicare ID - Type Unspecified