Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | LF073669 | MI |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | LF073669 | MI |
NPI | 1043279235 |
---|---|
Provider Name | Dr. Laith Anastas Farjo |
First Address | Brighton, MI 48114-7367 |
Second Address | Brighton, MI 48114-7367 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 28/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4379981 | (05) | MI |
G07694 | (02) | MI |