Provider Demographics
NPI:1528346053
Name:ELFAKI, DIAA ALDIN H (MD)
Entity type:Individual
Prefix:DR
First Name:DIAA ALDIN
Middle Name:H
Last Name:ELFAKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2725 AIRVIEW BLVD
Practice Address - Street 2:STE 105
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-1803
Practice Address - Country:US
Practice Address - Phone:269-349-8386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301099121207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine