Provider Demographics
NPI:1487108643
Name:YAHYA, FADIAH ALI
Entity type:Individual
Prefix:MS
First Name:FADIAH
Middle Name:ALI
Last Name:YAHYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5133 SAINT LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48210-2162
Mailing Address - Country:US
Mailing Address - Phone:313-629-2104
Mailing Address - Fax:
Practice Address - Street 1:5133 SAINT LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48210-2162
Practice Address - Country:US
Practice Address - Phone:313-629-2104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI$$$$$$$$$Medicaid