Provider Demographics
NPI:1417113044
Name:FATEH, ADNAN ALI (MD)
Entity Type:Individual
Prefix:
First Name:ADNAN
Middle Name:ALI
Last Name:FATEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42186 SARATOGA CIR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3535
Mailing Address - Country:US
Mailing Address - Phone:734-437-1954
Mailing Address - Fax:
Practice Address - Street 1:42186 SARATOGA CIR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3535
Practice Address - Country:US
Practice Address - Phone:734-437-1954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010855912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology