Provider Demographics
NPI:1538676788
Name:FARHADI, ALEXANDER A
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:A
Last Name:FARHADI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6165 INNKEEPERS CT APT 76
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-7821
Mailing Address - Country:US
Mailing Address - Phone:616-558-6516
Mailing Address - Fax:
Practice Address - Street 1:6165 INNKEEPERS CT APT 76
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-7821
Practice Address - Country:US
Practice Address - Phone:616-558-6516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program