Provider Demographics
NPI:1932468097
Name:ALYAS, FANAR (MD)
Entity Type:Individual
Prefix:DR
First Name:FANAR
Middle Name:
Last Name:ALYAS
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 1:2300 BIDDLE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-4650
Mailing Address - Country:US
Mailing Address - Phone:734-246-5705
Mailing Address - Fax:
Practice Address - Street 1:2300 BIDDLE AVE STE 100
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-4650
Practice Address - Country:US
Practice Address - Phone:732-246-5705
Practice Address - Fax:734-246-5750
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301107950207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine