Individual
FREDAZ FARES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2040 MONROE ST STE 207, DEARBORN, MI 48124-2950
(313) 278-5836
Mailing address
2040 MONROE ST STE 207, DEARBORN, MI 48124-2950
(313) 278-5836
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704317324
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3434247
—
MI
Enumeration date
10/24/2016
Last updated
01/08/2021
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