Healthcare Provider Details

I. General information

NPI: 1477634095
Provider Name (Legal Business Name): MICHIGAN COMPREHENSIVE FERTILITY CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18181 OAKWOOD BLVD SUITE 109
DEARBORN MI
48124-5032
US

IV. Provider business mailing address

PO BOX 673739
DETROIT MI
48267-3739
US

V. Phone/Fax

Practice location:
  • Phone: 313-299-6650
  • Fax: 313-299-6651
Mailing address:
  • Phone: 313-299-6650
  • Fax: 313-299-6651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberDM007496
License Number StateMI

VIII. Authorized Official

Name: DAVID MAGYAR
Title or Position: DIRECTOR,OWNER
Credential: DO
Phone: 313-299-6650