Individual
DR. EBRAHIM FAYAZI
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6071 W OUTER DR, DETROIT, MI 48235-2624
(313) 966-3246
Mailing address
PO BOX 321061, DETROIT, MI 48232-1061
(248) 543-8070
(248) 543-9005
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
4301035534
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4192660
—
MI
Enumeration date
06/02/2006
Last updated
11/29/2023
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