Provider Demographics
NPI:1487600474
Name:MUNA K. FARJO,M.D., P.C.
Entity type:Organization
Organization Name:MUNA K. FARJO,M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUNA
Authorized Official - Middle Name:K
Authorized Official - Last Name:FARJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-668-4700
Mailing Address - Street 1:3001 PLYMOUTH RD
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-3205
Mailing Address - Country:US
Mailing Address - Phone:734-668-4700
Mailing Address - Fax:
Practice Address - Street 1:3001 PLYMOUTH RD
Practice Address - Street 2:SUITE # 101
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-3205
Practice Address - Country:US
Practice Address - Phone:734-668-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301037565207N00000X, 207ND0900X, 207ZP0102X
MI3401037565208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI690H115140OtherBC/BS
MI2208114661OtherBC/BS
MI0P32200Medicare PIN
MI2208114661OtherBC/BS