Healthcare Provider Details

I. General information

NPI: 1831883529
Provider Name (Legal Business Name): AEGIS MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17888 MACK AVE
GROSSE POINTE MI
48230-6234
US

IV. Provider business mailing address

17888 MACK AVE
GROSSE POINTE MI
48230-6234
US

V. Phone/Fax

Practice location:
  • Phone: 888-849-1080
  • Fax:
Mailing address:
  • Phone: 888-849-1080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER FARAGO III
Title or Position: OWNER
Credential: MD
Phone: 888-849-1080