Provider Demographics
NPI:1841245263
Name:DAWOOD-FARAH, FARAH RAFIK (MD)
Entity Type:Individual
Prefix:
First Name:FARAH
Middle Name:RAFIK
Last Name:DAWOOD-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:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48068-0303
Mailing Address - Country:US
Mailing Address - Phone:586-580-0760
Mailing Address - Fax:
Practice Address - Street 1:1701 SOUTH BLVD E STE 190
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6124
Practice Address - Country:US
Practice Address - Phone:586-580-0760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065535207RE0101X
MA230152207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI7022Medicare PIN