Healthcare Provider Details

I. General information

NPI: 1295479251
Provider Name (Legal Business Name): COMPASSIONATE GYNECOLOGY OF MICHIGAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 N FENWAY DR
FENTON MI
48430-2666
US

IV. Provider business mailing address

445 N FENWAY DR
FENTON MI
48430-2666
US

V. Phone/Fax

Practice location:
  • Phone: 810-869-6086
  • Fax: 833-872-0085
Mailing address:
  • Phone: 810-869-6086
  • Fax: 833-872-0085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARTINIQUE KLING
Title or Position: OWNER
Credential: MD
Phone: 989-430-8964