Provider Demographics
NPI:1255705497
Name:AHMAD FARAH DPM PC
Entity type:Organization
Organization Name:AHMAD FARAH DPM PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:RAFEEK
Authorized Official - Last Name:FARAH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:734-675-7777
Mailing Address - Street 1:2105 WEST RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-3897
Mailing Address - Country:US
Mailing Address - Phone:734-675-7777
Mailing Address - Fax:734-675-7785
Practice Address - Street 1:2105 WEST RD
Practice Address - Street 2:SUITE A
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-3897
Practice Address - Country:US
Practice Address - Phone:734-675-7777
Practice Address - Fax:734-675-7785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-28
Last Update Date:2015-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002222213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1285730531OtherINDIVIDUAL MEDICARE NPI