Healthcare Provider Details

I. General information

NPI: 1134165632
Provider Name (Legal Business Name): FENTON MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N ADELAIDE ST
FENTON MI
48430-2670
US

IV. Provider business mailing address

102 N ADELAIDE ST
FENTON MI
48430-2670
US

V. Phone/Fax

Practice location:
  • Phone: 810-629-2245
  • Fax: 810-629-6535
Mailing address:
  • Phone: 810-629-2245
  • Fax: 810-629-6535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301038438
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH L DUNCAN
Title or Position: MEDICAL DOCTOR/OWNER
Credential:
Phone: 810-629-2245