Provider Demographics
NPI:1346419223
Name:MICHIGAN HOME VISITING PHYSICIANS PC
Entity Type:Organization
Organization Name:MICHIGAN HOME VISITING PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARES
Authorized Official - Middle Name:
Authorized Official - Last Name:YASIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-421-0900
Mailing Address - Street 1:24418 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1837
Mailing Address - Country:US
Mailing Address - Phone:313-427-8826
Mailing Address - Fax:313-427-8821
Practice Address - Street 1:24418 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1837
Practice Address - Country:US
Practice Address - Phone:313-427-8826
Practice Address - Fax:313-427-8821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicare UPIN