Provider Demographics
NPI:1649273947
Name:FARJO, AYAD A (MD)
Entity type:Individual
Prefix:DR
First Name:AYAD
Middle Name:A
Last Name:FARJO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 GENOA BUSINESS PARK DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-7004
Mailing Address - Country:US
Mailing Address - Phone:810-494-2020
Mailing Address - Fax:810-494-0127
Practice Address - Street 1:2305 GENOA BUSINESS PARK DR STE 250
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7006
Practice Address - Country:US
Practice Address - Phone:810-494-2020
Practice Address - Fax:810-494-0127
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068609207W00000X, 207WX0120X
WI45989-020207W00000X, 207WX0120X
IA34089207W00000X, 207WX0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34255200Medicaid
IA34089OtherPHYSICIAN LICENSE
MI4301068609OtherPHYSICIAN LICENSE
MI18-0-47-1724-1OtherBCBSM PIN#
WI45989-020OtherSTATE LICENSE NUMBER
MI4865295-10Medicaid
MI5315025069OtherCONTROLLED SUBSTNCE LCNSE
MIH23333Medicare UPIN
MIP30920001Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #