Provider Demographics
NPI:1225242449
Name:EL-FAKHARANY, MOHAMED MOUSTAFA (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:MOUSTAFA
Last Name:EL-FAKHARANY
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 1:44279 VASSAR ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1037
Mailing Address - Country:US
Mailing Address - Phone:313-207-6210
Mailing Address - Fax:
Practice Address - Street 1:44279 VASSAR ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-1037
Practice Address - Country:US
Practice Address - Phone:313-207-6210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079614207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P42010Medicare PIN