Provider Demographics
NPI:1093455081
Name:FAWAZ, ALAA (DPM)
Entity type:Individual
Prefix:DR
First Name:ALAA
Middle Name:
Last Name:FAWAZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14555 LEVAN RD STE E302
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5042
Mailing Address - Country:US
Mailing Address - Phone:734-591-6612
Mailing Address - Fax:734-591-6625
Practice Address - Street 1:14555 LEVAN RD STE E302
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5042
Practice Address - Country:US
Practice Address - Phone:734-591-6612
Practice Address - Fax:734-591-6625
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5901400551213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery