| Faith Internal Medicine Pllc | |
|
15645 Farmington Rd Ste A Livonia MI 48154-2851 | |
| (734) 464-7600 | |
| (734) 464-9797 |
| Full Name | Faith Internal Medicine Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 15645 Farmington Rd Ste A, Livonia, Michigan |
| Authorized Official Name and Position | Laith Jacob (OWNER) |
| Authorized Official Contact | 2482456533 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Faith Internal Medicine Pllc 15645 Farmington Rd Ste A Livonia MI 48154-2851 Ph: (734) 464-7600 | Faith Internal Medicine Pllc 15645 Farmington Rd Ste A Livonia MI 48154-2851 Ph: (734) 464-7600 |
| NPI Number | 1568184570 |
|---|---|
| Provider Enumeration Date | 09/15/2022 |
| Last Update Date | 09/15/2022 |
| Medicare PECOS PAC ID | 3779959127 |
|---|---|
| Medicare Enrollment ID | O20221026002025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568184570 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Laith J Jacob |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083064000 PECOS PAC ID: 4082909395 Enrollment ID: I20191112001413 |
| Provider Name | Kimberly Ann Ison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215654710 PECOS PAC ID: 4486025491 Enrollment ID: I20230130000324 |
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