Provider Demographics
NPI:1811221104
Name:FARAH, CARL E (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:E
Last Name:FARAH
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 1:1616 KIRTS BLVD
Mailing Address - Street 2:206
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1616 KIRTS BLVD
Practice Address - Street 2:206
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4348
Practice Address - Country:US
Practice Address - Phone:202-492-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI430108696862085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology