Provider Demographics
NPI:1841242989
Name:FAKIH-ELMENINI, IMAN (MD)
Entity Type:Individual
Prefix:
First Name:IMAN
Middle Name:
Last Name:FAKIH-ELMENINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25516 FORD RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3022
Mailing Address - Country:US
Mailing Address - Phone:313-792-0000
Mailing Address - Fax:313-359-9333
Practice Address - Street 1:25516 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-3022
Practice Address - Country:US
Practice Address - Phone:313-792-0000
Practice Address - Fax:313-359-9333
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065945207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4096304Medicaid
MIM91020002Medicare ID - Type Unspecified
MIH07302Medicare UPIN