Healthcare Provider Details

I. General information

NPI: 1962569467
Provider Name (Legal Business Name): KATHLEEN FARQUHAR PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 COMMERCE RD
COMMERCE TOWNSHIP MI
48382-4413
US

IV. Provider business mailing address

8800 COMMERCE RD
COMMERCE TOWNSHIP MI
48382-4413
US

V. Phone/Fax

Practice location:
  • Phone: 248-363-7500
  • Fax: 248-363-7700
Mailing address:
  • Phone: 248-363-7500
  • Fax: 248-363-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601003263
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: