Healthcare Provider Details

I. General information

NPI: 1326129693
Provider Name (Legal Business Name): BFG FAMILY PRACTICE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15000 GRATIOT AVE STE 110
DETROIT MI
48205-1973
US

IV. Provider business mailing address

15000 GRATIOT AVE STE 110
DETROIT MI
48205-1973
US

V. Phone/Fax

Practice location:
  • Phone: 313-245-1417
  • Fax: 313-245-1332
Mailing address:
  • Phone: 313-245-1417
  • Fax: 313-245-1332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. GEORGE FADOOL
Title or Position: PARTNER
Credential: DO
Phone: 313-245-1417