Basic Information
| Provider Information | |||||||||
| NPI: | 1285730531 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARAH | ||||||||
| FirstName: | AHMAD | ||||||||
| MiddleName: | RAFEEK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2105 WEST ROAD | ||||||||
| Address2: | |||||||||
| City: | TRENTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346757777 | ||||||||
| FaxNumber: | 7346757785 | ||||||||
| Practice Location | |||||||||
| Address1: | 2105 WEST ROAD | ||||||||
| Address2: | |||||||||
| City: | TRENTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346757777 | ||||||||
| FaxNumber: | 7346757785 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2006 | ||||||||
| LastUpdateDate: | 05/03/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 5901002222 | MI | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | P58180002 | 01 | MI | MEDICARE PTAN | OTHER | 1881852887 | 01 | MI | GROUP NPI | OTHER | 50136 | 01 | HEALTH PLAN OF MICHIGAN | OTHER | 5901002222 | 01 | MI | MICHIGAN STATE LICENSE | OTHER | 9365124 | 01 | MI | PPOM COFINITY | OTHER | 4858218080 | 01 | MI | BC PIN | OTHER |