Provider Demographics
NPI:1154610335
Name:HAFEEZ, FARRAH (DO)
Entity type:Individual
Prefix:DR
First Name:FARRAH
Middle Name:
Last Name:HAFEEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80600 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:BRUCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48065-1333
Mailing Address - Country:US
Mailing Address - Phone:810-798-6560
Mailing Address - Fax:
Practice Address - Street 1:80600 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:BRUCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48065-1333
Practice Address - Country:US
Practice Address - Phone:810-798-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019545207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1154610335Medicaid
MI1154610335Medicaid