Provider Demographics
NPI:1841591328
Name:FATHY F. ISHAC, MD, P.C.
Entity Type:Organization
Organization Name:FATHY F. ISHAC, MD, P.C.
Other - Org Name:F.F. ISHAC, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FATHY
Authorized Official - Middle Name:FARID
Authorized Official - Last Name:ISHAC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-478-8300
Mailing Address - Street 1:18475 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3200
Mailing Address - Country:US
Mailing Address - Phone:248-478-8300
Mailing Address - Fax:248-478-8410
Practice Address - Street 1:18475 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3200
Practice Address - Country:US
Practice Address - Phone:248-478-8300
Practice Address - Fax:248-478-8410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIFI028985101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty