NPIMap

Individual provider Active NPI

Rodwan Fadlallah, M.D.

  • Internal Medicine Physician
  • Dearborn Heights, MI
National Provider Identifier
1255772604
Registry record updated Feb 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301103085 Issued in MI
Practice address
27250 Cherry Hill Rd
Dearborn Heights, MI 48127-3677
Phone
(313) 406-2222
Fax
(313) 908-2687
NPI assigned
Jul 15, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301103085 MI Primary
Pediatrics Physician 208000000X 4301103085 MI

Addresses

Primary practice location

27250 Cherry Hill Rd
Dearborn Heights, MI 48127-3677

Mailing address

27250 Cherry Hill Rd
Dearborn Heights, MI 48127-3677
Phone (313) 406-2222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170308000458 MI Practitioner - Internal MedicinePractitioner - Pediatric Medicine 5799918967 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fastcare MD Urgent Care PCGroup PAC ID 2062757479, 2 clinicians

Practice addresses (Care Compare)

27250 Cherry Hill Rd
Dearborn Heights, MI 48127-3677
Phone (313) 406-2222

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301103085MIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fastcaremd Urgent Care PC CurrentSince Oct 15, 2018 Accepting new patients
Michigan Primary Care Center PC Internal Medicine CurrentSince Oct 15, 2018 Accepting new patients

Locations

27250 Cherry Hill Rd
Dearborn Heights, MI 48127
Phone (313) 406-2222

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1373846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677024000000",
    "number": "1255772604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27250 CHERRY HILL RD",
            "city": "DEARBORN HEIGHTS",
            "state": "MI",
            "postal_code": "481273677",
            "telephone_number": "313-406-2222",
            "fax_number": "313-908-2687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27250 CHERRY HILL RD",
            "city": "DEARBORN HEIGHTS",
            "state": "MI",
            "postal_code": "481273677",
            "telephone_number": "313-406-2222",
            "fax_number": "313-908-2687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FADLALLAH",
        "first_name": "RODWAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-15",
        "last_updated": "2023-02-22",
        "certification_date": "2022-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301103085",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301103085",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn Heights, MI

Sources for this page

Verify at the official NPI Registry.