Healthcare Provider Details

I. General information

NPI: 1427166313
Provider Name (Legal Business Name): CATHY FAKLER AZZARELLO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHY R FAKLER M.D.

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CAMPUS DR
HANCOCK MI
49930-1452
US

IV. Provider business mailing address

301 EXPLORER ST
GWINN MI
49841-2813
US

V. Phone/Fax

Practice location:
  • Phone: 906-483-1700
  • Fax: 906-372-3230
Mailing address:
  • Phone: 906-346-4924
  • Fax: 906-372-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301111513
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: