Provider Demographics
NPI:1679397053
Name:MAROGE, FARAS
Entity type:Individual
Prefix:
First Name:FARAS
Middle Name:
Last Name:MAROGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28166 SAINT LOUISE DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-2494
Mailing Address - Country:US
Mailing Address - Phone:248-657-0964
Mailing Address - Fax:
Practice Address - Street 1:28166 SAINT LOUISE DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-2494
Practice Address - Country:US
Practice Address - Phone:248-657-0964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374U00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide