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Individual

DR. FARID T FATA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1901 STAR BATT DR, SUITE 200, ROCHESTER HILLS, MI 48309-3712
(248) 844-5690
(248) 844-5691
Mailing address
1901 STAR BATT DR, SUITE 200, ROCHESTER HILLS, MI 48309-3712
(248) 844-5690
(248) 844-5691

Taxonomy

Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
FF072629
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0634811
BCBSM
MI
01
4301072629
STATE LICENSE
MI
01
5315009042
CONTROLLED DRUG LICENSE
MI
Enumeration date
08/25/2006
Last updated
06/16/2011
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