Provider Demographics
NPI:1609871771
Name:FARRA, MOHAMMAD WASEEM (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:WASEEM
Last Name:FARRA
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 1:29275 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2817
Mailing Address - Country:US
Mailing Address - Phone:248-350-2722
Mailing Address - Fax:248-350-0154
Practice Address - Street 1:29275 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-2817
Practice Address - Country:US
Practice Address - Phone:248-350-2722
Practice Address - Fax:248-350-0154
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067318207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F37521OtherBLUE CROSS BLUE SHIELD
MI4292155Medicaid
MIH04791Medicare UPIN
MI0F37521OtherBLUE CROSS BLUE SHIELD