Provider Demographics
NPI:1346832193
Name:MY DOCTORS CLINIC PLLC
Entity Type:Organization
Organization Name:MY DOCTORS CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAOUD
Authorized Official - Middle Name:A
Authorized Official - Last Name:FARAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-908-9004
Mailing Address - Street 1:13530 MICHIGAN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3555
Mailing Address - Country:US
Mailing Address - Phone:313-908-9004
Mailing Address - Fax:313-908-7873
Practice Address - Street 1:4353 MAPLE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3535
Practice Address - Country:US
Practice Address - Phone:313-908-0004
Practice Address - Fax:313-908-7873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty