Provider Demographics
NPI:1881852887
Name:RAFEEK M FARAH MD PC
Entity Type:Organization
Organization Name:RAFEEK M FARAH MD PC
Other - Org Name:FARAH MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFEEK
Authorized Official - Middle Name:MAHMOUD
Authorized Official - Last Name:FARAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-675-7777
Mailing Address - Street 1:2105 WEST RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-3897
Mailing Address - Country:US
Mailing Address - Phone:734-675-7777
Mailing Address - Fax:734-675-7785
Practice Address - Street 1:2105 WEST RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-3897
Practice Address - Country:US
Practice Address - Phone:734-675-7777
Practice Address - Fax:734-675-7785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034322207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P58180OtherMEDICARE P-TAN
MI2104935Medicaid
MIE26578Medicare UPIN
MI6129030001Medicare NSC