Provider Demographics
NPI:1780850974
Name:FARES, SALAH (MD)
Entity Type:Individual
Prefix:
First Name:SALAH
Middle Name:
Last Name:FARES
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 1:1111 MEDICAL PLAZA DRIVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3477
Mailing Address - Country:US
Mailing Address - Phone:281-296-8788
Mailing Address - Fax:
Practice Address - Street 1:27211 LAHSER RD
Practice Address - Street 2:STE # 200
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-8469
Practice Address - Country:US
Practice Address - Phone:248-358-4982
Practice Address - Fax:248-358-5125
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3670207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1346398971OtherGRP NPI
MI11-0F33636-0OtherBCBSM
MI4301087647OtherLICENSE
MI20-5485614OtherTAX ID
MI20-5485614OtherTAX ID