Provider Demographics
NPI:1679592877
Name:DAKHLALLAH, FOUAD A (MD)
Entity type:Individual
Prefix:DR
First Name:FOUAD
Middle Name:A
Last Name:DAKHLALLAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5728 SCHAEFER RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2298
Mailing Address - Country:US
Mailing Address - Phone:313-581-8080
Mailing Address - Fax:313-581-8383
Practice Address - Street 1:5728 SCHAEFER RD
Practice Address - Street 2:SUITE 103
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2298
Practice Address - Country:US
Practice Address - Phone:313-581-8080
Practice Address - Fax:313-581-8383
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301085126207R00000X
MIFD085126207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4753252Medicaid
MII47282Medicare UPIN