Provider Demographics
NPI:1790021673
Name:MONA FAKIH DO PC
Entity Type:Organization
Organization Name:MONA FAKIH DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR./ PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MONA
Authorized Official - Middle Name:YOUSSEF
Authorized Official - Last Name:FAKIH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-277-0400
Mailing Address - Street 1:25150 FORD RD
Mailing Address - Street 2:STE 200
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3115
Mailing Address - Country:US
Mailing Address - Phone:313-277-0400
Mailing Address - Fax:
Practice Address - Street 1:25150 FORD ROAD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127
Practice Address - Country:US
Practice Address - Phone:313-277-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-20
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty