Provider Demographics
NPI:1134637010
Name:FAQI, MAXAMED ABDISALAN
Entity Type:Individual
Prefix:
First Name:MAXAMED
Middle Name:ABDISALAN
Last Name:FAQI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5810 SOUTHWYCK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1514
Mailing Address - Country:US
Mailing Address - Phone:419-936-8629
Mailing Address - Fax:419-261-7482
Practice Address - Street 1:5810 SOUTHWYCK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1514
Practice Address - Country:US
Practice Address - Phone:419-936-8629
Practice Address - Fax:419-261-7482
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-13
Last Update Date:2018-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH418-99999343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)