Basic Information
| Provider Information | |||||||||
| NPI: | 1790021673 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONA FAKIH DO PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25150 FORD RD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | DEARBORN HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481273115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132770400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25150 FORD ROAD | ||||||||
| Address2: | |||||||||
| City: | DEARBORN HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132770400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2012 | ||||||||
| LastUpdateDate: | 08/07/2013 | ||||||||
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| AuthorizedOfficialLastName: | FAKIH | ||||||||
| AuthorizedOfficialFirstName: | MONA | ||||||||
| AuthorizedOfficialMiddleName: | YOUSSEF | ||||||||
| AuthorizedOfficialTitleorPosition: | DR./ PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 3132770400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.