Provider Demographics
NPI:1225453475
Name:FAHS SURGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:FAHS SURGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:SHADI
Authorized Official - Middle Name:
Authorized Official - Last Name:FAHS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-353-8779
Mailing Address - Street 1:23855 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1805
Mailing Address - Country:US
Mailing Address - Phone:313-353-8779
Mailing Address - Fax:313-769-5658
Practice Address - Street 1:23855 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1805
Practice Address - Country:US
Practice Address - Phone:313-353-8779
Practice Address - Fax:313-769-5658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014583208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty