Provider Demographics
NPI:1184643520
Name:SOKHANDON, FARNOOSH (MD)
Entity Type:Individual
Prefix:
First Name:FARNOOSH
Middle Name:
Last Name:SOKHANDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26901 BEAUMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3601 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6712
Practice Address - Country:US
Practice Address - Phone:248-898-6064
Practice Address - Fax:248-898-5490
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL269152085R0202X
MI43010750442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051530584OtherBLUE CROSS
AL009933904Medicaid
AL009933906Medicaid
ALP00263170OtherRAILROAD MEDICARE
AL009933903Medicaid
AL009937046Medicaid
ALP00263169OtherRAILROAD MEDICARE
AL051530583OtherBLUE CROSS
MS2483384OtherMISSISSIPPI MEDICAID
AL051530582OtherBLUE CROSS
AL051534463OtherBLUE CROSS
AL009933907Medicaid
AL051530585OtherBLUE CROSS
AL009937046Medicaid