Provider Demographics
NPI:1992118152
Name:ARAFAT, FARAH ANN (PA-C)
Entity type:Individual
Prefix:MISS
First Name:FARAH
Middle Name:ANN
Last Name:ARAFAT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 WALNUT RUN CT
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-2606
Mailing Address - Country:US
Mailing Address - Phone:248-762-0453
Mailing Address - Fax:
Practice Address - Street 1:1510 WALNUT RUN CT
Practice Address - Street 2:
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-2606
Practice Address - Country:US
Practice Address - Phone:248-762-0453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant