Provider Demographics
NPI:1912674060
Name:MEHRABAN FAR, SINA
Entity Type:Individual
Prefix:
First Name:SINA
Middle Name:
Last Name:MEHRABAN FAR
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:DEPARTMENT OF UROLOGY, UHC, SUITE 7-C
Mailing Address - Street 2:4201 ST. ANTOINE
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-577-5222
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF UROLOGY, UHC, SUITE 7-C
Practice Address - Street 2:4201 ST. ANTOINE
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-577-5222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351048643208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty