Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | MD018776E | PA |
NPI | 1215973565 |
---|---|
Provider Name | Michael S Fakhraee |
First Address | Philadelphia, PA 19111-2431 |
Second Address | Philadelphia, PA 19111-2431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 29/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0052487000 | KEYSONE HEALTH PLAN EAST (01) | PA |
400138 | BLUE CROSS &BLUE SHIELD (01) | PA |
400138 | FEDERAL BLUE CROSS (01) | PA |
400138 | PERSONAL CHOICE (01) | PA |