Provider Demographics
NPI:1477542579
Name:FARHY, RODOLFO D (MD)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:D
Last Name:FARHY
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 1:18915 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2575
Mailing Address - Country:US
Mailing Address - Phone:248-655-4490
Mailing Address - Fax:248-655-4491
Practice Address - Street 1:18915 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2575
Practice Address - Country:US
Practice Address - Phone:248-655-4490
Practice Address - Fax:248-655-4491
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301061075207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4573601-01Medicaid
MI060631727OtherBCBSM
MI060631727OtherBCBSM
G71291Medicare UPIN