Provider Demographics
NPI:1265310338
Name:DEARBORN PED & ADOL MED CENTER II PLLC
Entity type:Organization
Organization Name:DEARBORN PED & ADOL MED CENTER II PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:FAKIH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-605-1111
Mailing Address - Street 1:2547 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3013
Mailing Address - Country:US
Mailing Address - Phone:313-791-8300
Mailing Address - Fax:313-791-8302
Practice Address - Street 1:2547 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3013
Practice Address - Country:US
Practice Address - Phone:313-791-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care