Provider Demographics
NPI:1306718358
Name:DABAJA, FATIMA TAREK
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:TAREK
Last Name:DABAJA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44195 CROFTON CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-1909
Mailing Address - Country:US
Mailing Address - Phone:313-241-1617
Mailing Address - Fax:
Practice Address - Street 1:44195 CROFTON CT
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1909
Practice Address - Country:US
Practice Address - Phone:313-241-1617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QS1000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health