Provider Demographics
NPI:1275736936
Name:FARIS, VICTOR SAMIR (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:SAMIR
Last Name:FARIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1010 N CAMPBELL RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1570
Mailing Address - Country:US
Mailing Address - Phone:248-850-8395
Mailing Address - Fax:
Practice Address - Street 1:1010 N CAMPBELL RD
Practice Address - Street 2:SUITE #3
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1570
Practice Address - Country:US
Practice Address - Phone:248-850-8395
Practice Address - Fax:248-850-8495
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI1865828207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0809306492OtherBCBS IND
MI1275736936Medicaid
MI1275736936Medicaid