Healthcare Provider Details

I. General information

NPI: 1942452552
Provider Name (Legal Business Name): PETER FARAGO III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17888 MACK AVE
GROSSE POINTE MI
48230-6234
US

IV. Provider business mailing address

77 STEPHENS RD
GROSSE POINTE FARMS MI
48236-3624
US

V. Phone/Fax

Practice location:
  • Phone: 519-258-4771
  • Fax: 519-258-4793
Mailing address:
  • Phone: 313-670-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number4301093157
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301093157
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: