Provider Demographics
NPI:1245839752
Name:DAOUD FARAJ PC
Entity type:Organization
Organization Name:DAOUD FARAJ PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DAOUD
Authorized Official - Middle Name:A
Authorized Official - Last Name:FARAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-701-4340
Mailing Address - Street 1:4524 KINGSTON ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-3240
Mailing Address - Country:US
Mailing Address - Phone:313-682-7770
Mailing Address - Fax:
Practice Address - Street 1:13530 MICHIGAN AVE STE 300
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3555
Practice Address - Country:US
Practice Address - Phone:313-908-0004
Practice Address - Fax:313-908-7873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-26
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center