Individual
FAWWAZ HUMAYUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD.
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 916-2600
Mailing address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 916-2600
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301081942
MI
207R00000X
Internal Medicine Physician
A105464
CA
208M00000X
Hospitalist Physician
4301081942
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A1054640
—
CA
05
—
490636010
—
MI
01
—
700H262220
BLUE CROSS-BLUE CROSS
—
01
—
FH081942
COMMERCIAL-COMMERCIAL NUMBER
—
Enumeration date
08/05/2006
Last updated
11/01/2023
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