Provider Demographics
NPI:1417231317
Name:FOUAD A. DAKHLALLAH,M.D.,P.C.
Entity Type:Organization
Organization Name:FOUAD A. DAKHLALLAH,M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FOUAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAKHLALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-969-0278
Mailing Address - Street 1:340 NORBORNE AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3758
Mailing Address - Country:US
Mailing Address - Phone:313-562-6000
Mailing Address - Fax:313-562-6002
Practice Address - Street 1:6221 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2587
Practice Address - Country:US
Practice Address - Phone:313-969-0278
Practice Address - Fax:313-581-8383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085126207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4753252Medicaid