Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Faesal Elbakoush

Individual provider Neonatal-Perinatal Medicine Physician · NPI 1336545417

Faesal Elbakoush is a Pediatric Medicine in Detroit, Michigan. Qualified in 2004, 22 years ago. Practices with Henry Ford Health St John Hospital, a 330-clinician group and accepts Medicare assignment. Licensed in Arizona, Georgia and Michigan.

Years since qualifying
22
Licensed in
AZ, GA, MI
In the registry since
2014
Specialties on file
4
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Practice location Address checks out

22101 Moross Rd Fl CCB5
Detroit, MI 48236-2148
Phone: (313) 343-4000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Neonatal-Perinatal Medicine Physician (primary) Taxonomy 2080N0001X · Licence 4301106817 (MI)
Neonatal-Perinatal Medicine Physician Taxonomy 2080N0001X · Licence 110897 (GA)
Pediatrics Physician Taxonomy 208000000X · Licence 4301106817 (MI)
Neonatal-Perinatal Medicine Physician Taxonomy 2080N0001X · Licence 79871 (AZ)

Record details

NPI number1336545417
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedNovember 17, 2014
Last updated in NPPESJuly 21, 2026
Certification dateJuly 21, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPEDIATRIC MEDICINE
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Group practice Henry Ford Health St. John Hospital — 330 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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