Provider Demographics
NPI:1518213842
Name:SAHHAR, FATIN ANTUWAN (M D)
Entity Type:Individual
Prefix:
First Name:FATIN
Middle Name:ANTUWAN
Last Name:SAHHAR
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19460 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-1200
Mailing Address - Country:US
Mailing Address - Phone:313-387-1097
Mailing Address - Fax:313-387-8795
Practice Address - Street 1:19460 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-1200
Practice Address - Country:US
Practice Address - Phone:313-387-1097
Practice Address - Fax:313-387-8795
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301101666207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine