Provider Demographics
NPI:1235155524
Name:FARES, ZOUHEIR (DO)
Entity Type:Individual
Prefix:DR
First Name:ZOUHEIR
Middle Name:
Last Name:FARES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8384 HOLLY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1976
Mailing Address - Country:US
Mailing Address - Phone:810-733-8400
Mailing Address - Fax:810-733-2634
Practice Address - Street 1:8384 HOLLY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1976
Practice Address - Country:US
Practice Address - Phone:810-733-8400
Practice Address - Fax:810-733-2634
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008104208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1931600 TYPE 11Medicaid
MI0252501065OtherBLUE CROSS BLUE SHIELD
MIF03647Medicare UPIN
MI0252501065OtherBLUE CROSS BLUE SHIELD
MI0P22180Medicare ID - Type Unspecified