Provider Demographics
NPI:1255410940
Name:ZOUHEIR FARES
Entity type:Organization
Organization Name:ZOUHEIR FARES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZOUHEIR
Authorized Official - Middle Name:
Authorized Official - Last Name:FARES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-733-8400
Mailing Address - Street 1:8384 HOLLY RD STE 1
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1974
Mailing Address - Country:US
Mailing Address - Phone:810-733-8400
Mailing Address - Fax:810-733-2634
Practice Address - Street 1:8384 HOLLY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1976
Practice Address - Country:US
Practice Address - Phone:810-733-8400
Practice Address - Fax:810-733-2634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2013-12-30
Deactivation Date:2007-02-28
Deactivation Code:
Reactivation Date:2007-10-11
Provider Licenses
StateLicense IDTaxonomies
MI5101008104208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0252501065OtherBLUE CROSS BLUE SHIELD
MI1931600MedicaidTYPE 11
MI0P22180Medicare PIN
MI1931600MedicaidTYPE 11
MI0P31270Medicare PIN