Provider Demographics
NPI:1871624031
Name:MICHAEL S FAKHRAEE MD ASSOCIATES
Entity type:Organization
Organization Name:MICHAEL S FAKHRAEE MD ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:FAKHRAEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-728-8200
Mailing Address - Street 1:7500 CENTRAL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2430
Mailing Address - Country:US
Mailing Address - Phone:215-728-8200
Mailing Address - Fax:215-725-3209
Practice Address - Street 1:7500 CENTRAL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2430
Practice Address - Country:US
Practice Address - Phone:215-728-8200
Practice Address - Fax:215-725-3209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0052487000OtherKEYSTONE HEALTH PLAN EAS
PA0052487000OtherKEYSTONE 65
PA400138OtherINDEPENDENCE BCBS
PA400138OtherBLUE CROSS & BLUE SHILED
PA400138OtherBC & BS FEDERAL
PA400138OtherPERSONAL CHOICE BCBS
PA400138Medicare PIN
PA400138OtherBC & BS FEDERAL