Provider Demographics
NPI:1891119566
Name:ABDELKADER H. FARES, M.D., P.C.
Entity Type:Organization
Organization Name:ABDELKADER H. FARES, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDELKADER
Authorized Official - Middle Name:H
Authorized Official - Last Name:FARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-843-1973
Mailing Address - Street 1:9925 DIX
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1593
Mailing Address - Country:US
Mailing Address - Phone:313-843-1973
Mailing Address - Fax:313-843-1961
Practice Address - Street 1:9925 DIX
Practice Address - Street 2:SUITE 105
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1593
Practice Address - Country:US
Practice Address - Phone:313-843-1973
Practice Address - Fax:313-843-1961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF04301043357302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization