Provider Demographics
NPI:1629003132
Name:FATIMA HEALTH CARE,P.C.
Entity Type:Organization
Organization Name:FATIMA HEALTH CARE,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INSHAD
Authorized Official - Middle Name:H
Authorized Official - Last Name:BEYDOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-582-0217
Mailing Address - Street 1:1135 FALCON ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1341
Mailing Address - Country:US
Mailing Address - Phone:313-582-0217
Mailing Address - Fax:
Practice Address - Street 1:4789 WESTLAND ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2809
Practice Address - Country:US
Practice Address - Phone:313-582-0217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003140261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080H232870OtherBCBS
MI0P34350Medicare PIN