Provider Demographics
NPI:1548350531
Name:ELHASAN-FAKIH, LOBNA (MD)
Entity type:Individual
Prefix:DR
First Name:LOBNA
Middle Name:
Last Name:ELHASAN-FAKIH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2547 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3013
Mailing Address - Country:US
Mailing Address - Phone:313-528-3700
Mailing Address - Fax:313-582-3301
Practice Address - Street 1:2547 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3013
Practice Address - Country:US
Practice Address - Phone:313-528-3700
Practice Address - Fax:313-791-8302
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010641082080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104713462Medicaid
MI103479230Medicaid