Provider Demographics
NPI:1790233229
Name:FARAJ, ZIYAD
Entity Type:Individual
Prefix:
First Name:ZIYAD
Middle Name:
Last Name:FARAJ
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 1:651 N WAVERLY ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1627
Mailing Address - Country:US
Mailing Address - Phone:313-995-1738
Mailing Address - Fax:
Practice Address - Street 1:651 N WAVERLY ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128-1627
Practice Address - Country:US
Practice Address - Phone:313-995-1738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIF620982461537172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver