Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 1865828 | MI |
Y | 207QS0010X | Family Doctor - Sports Medicine | 1865828 | MI |
NPI | 1275736936 |
---|---|
Provider Name | Dr. Victor Samir Faris |
First Address | Royal Oak, MI 48067-1570 |
Second Address | Royal Oak, MI 48067-1570 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2007 |
Last Update Date | 27/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0809306492 | BCBS IND (01) | MI |
1275736936 | (05) | MI |