Healthcare Provider Details

I. General information

NPI: 1568496370
Provider Name (Legal Business Name): FARMINGTON EMERGENCY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28050 GRAND RIVER AVENUE ER DEPT
FARMINGTON HILLS MI
48336
US

IV. Provider business mailing address

PO BOX 634087
CINCINNATI OH
45263
US

V. Phone/Fax

Practice location:
  • Phone: 248-471-8000
  • Fax:
Mailing address:
  • Phone: 800-540-8739
  • Fax: 616-975-9827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DIANE KAISER
Title or Position: PHYSICIAN
Credential: DO
Phone: 800-540-8739