Provider Demographics
NPI:1134424021
Name:ALRAIS, FARAH S (PA)
Entity type:Individual
Prefix:MRS
First Name:FARAH
Middle Name:S
Last Name:ALRAIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43145 SCHOENHERR RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-1955
Mailing Address - Country:US
Mailing Address - Phone:586-997-5048
Mailing Address - Fax:586-997-5049
Practice Address - Street 1:43145 SCHOENHERR RD
Practice Address - Street 2:SUITE 200
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1955
Practice Address - Country:US
Practice Address - Phone:586-997-5048
Practice Address - Fax:586-997-5049
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005949363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5632252OtherBCBSM
MI5601005949OtherSTATE LICENSE
MIP17390008Medicare PIN
MI5632252OtherBCBSM