Provider Demographics
NPI:1134355399
Name:MOUSTARAH, FADY (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:FADY
Middle Name:
Last Name:MOUSTARAH
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 724
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48121-0724
Mailing Address - Country:US
Mailing Address - Phone:989-980-4995
Mailing Address - Fax:
Practice Address - Street 1:43494 WOODWARD AVE STE 202
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5054
Practice Address - Country:US
Practice Address - Phone:248-334-5444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-01683208600000X
OH35. 092350208600000X
MI4301108768208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty