Provider Demographics
NPI:1851719991
Name:YASSO, FADY
Entity Type:Individual
Prefix:
First Name:FADY
Middle Name:
Last Name:YASSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30055 NORTHWESTERN HWY STE 170
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3231
Mailing Address - Country:US
Mailing Address - Phone:248-539-0729
Mailing Address - Fax:248-539-0740
Practice Address - Street 1:30055 NORTHWESTERN HWY STE 170
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3231
Practice Address - Country:US
Practice Address - Phone:248-539-0729
Practice Address - Fax:248-539-0740
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301105867207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine