Provider Demographics
NPI:1699189456
Name:NOSSONI, FARIDEDDIN (DO)
Entity type:Individual
Prefix:
First Name:FARIDEDDIN
Middle Name:
Last Name:NOSSONI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DRIVE
Mailing Address - Street 2:SUITE J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:19000 ST JOE'S PARKWAY
Practice Address - Street 2:SUITE 310
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152
Practice Address - Country:US
Practice Address - Phone:810-494-6830
Practice Address - Fax:810-494-6834
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2022-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101020975208600000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery