Provider Demographics
NPI:1821166737
Name:FAITH PRIMARY CARE, PC
Entity Type:Organization
Organization Name:FAITH PRIMARY CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-533-3720
Mailing Address - Street 1:22341 WEST EIGHT MILE ROAD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219
Mailing Address - Country:US
Mailing Address - Phone:313-533-3720
Mailing Address - Fax:313-533-3283
Practice Address - Street 1:315 S WAYNE RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-4301
Practice Address - Country:US
Practice Address - Phone:734-895-8396
Practice Address - Fax:734-895-8571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078766261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center