Provider Demographics
NPI:1477547297
Name:ABDULNOUR-FARJO, RAND (MD)
Entity Type:Individual
Prefix:
First Name:RAND
Middle Name:
Last Name:ABDULNOUR-FARJO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RAND
Other - Middle Name:
Other - Last Name:ABDULNOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22201 MOROSS RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2169
Mailing Address - Country:US
Mailing Address - Phone:313-343-3481
Mailing Address - Fax:313-343-7937
Practice Address - Street 1:22201 MOROSS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2169
Practice Address - Country:US
Practice Address - Phone:313-343-3481
Practice Address - Fax:313-343-7937
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010677852080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4455027Medicaid
MI4455027Medicaid
H78105Medicare UPIN