Provider Demographics
NPI:1104896695
Name:ZAKARIA, FAYDA (MD)
Entity type:Individual
Prefix:DR
First Name:FAYDA
Middle Name:
Last Name:ZAKARIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5575 MEADOW WOOD LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-4028
Mailing Address - Country:US
Mailing Address - Phone:313-562-6607
Mailing Address - Fax:313-562-5851
Practice Address - Street 1:2200 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3058
Practice Address - Country:US
Practice Address - Phone:313-562-6607
Practice Address - Fax:313-562-5851
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIFZ078213207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIFZ078213OtherLICENSE
MI700H219330OtherBLUE CROSS
MI700H219330OtherBLUE CROSS
MION57270008Medicare ID - Type Unspecified