Provider Demographics
NPI:1457528283
Name:DARWICHE, HUSSEIN FADL
Entity Type:Individual
Prefix:
First Name:HUSSEIN
Middle Name:FADL
Last Name:DARWICHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5409 WILLIAMSON ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3171
Mailing Address - Country:US
Mailing Address - Phone:313-641-1011
Mailing Address - Fax:
Practice Address - Street 1:4201 SAINT ANTOINE ST
Practice Address - Street 2:SUITE 6B2
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-1315
Practice Address - Fax:313-745-1316
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57012482207X00000X
MI4301086407207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301086407OtherLICENSE