Provider Demographics
NPI:1255459210
Name:RODOLFO D FARHY, MD, FACC, FAHA, PLLC
Entity type:Organization
Organization Name:RODOLFO D FARHY, MD, FACC, FAHA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:D
Authorized Official - Last Name:FARHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-655-4490
Mailing Address - Street 1:18915 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2575
Mailing Address - Country:US
Mailing Address - Phone:248-655-4490
Mailing Address - Fax:248-655-4491
Practice Address - Street 1:18915 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2575
Practice Address - Country:US
Practice Address - Phone:248-655-4490
Practice Address - Fax:248-655-4491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301061075174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG71291Medicare UPIN
MI0N82900Medicare ID - Type Unspecified