Provider Demographics
NPI:1124667217
Name:FAGHIHI, MOHAMMAD ALI (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:ALI
Last Name:FAGHIHI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 SW 152ND ST STE 209
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1942
Mailing Address - Country:US
Mailing Address - Phone:786-250-3419
Mailing Address - Fax:786-250-3074
Practice Address - Street 1:9000 SW 152ND ST STE 209
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1942
Practice Address - Country:US
Practice Address - Phone:786-250-3419
Practice Address - Fax:786-250-3074
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDI51888207SG0205X, 207ZP0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology
No207SG0205XAllopathic & Osteopathic PhysiciansMedical GeneticsPh.D. Medical Genetics