Healthcare Provider Details

I. General information

NPI: 1568567006
Provider Name (Legal Business Name): ALFRED M FAULKNER DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21031 MICHIGAN AVE
DEARBORN MI
48124-2339
US

IV. Provider business mailing address

21031 MICHIGAN AVE
DEARBORN MI
48124-2339
US

V. Phone/Fax

Practice location:
  • Phone: 313-277-3585
  • Fax: 313-277-2483
Mailing address:
  • Phone: 313-277-3585
  • Fax: 313-277-2483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: ALFRED M FAULKNER
Title or Position: ORTHOPEDIC SURGEON PRESIDENT
Credential: DO
Phone: 313-277-6700