Healthcare Provider Details

I. General information

NPI: 1326160797
Provider Name (Legal Business Name): CATHERINE MCAULEY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 BYRON RD STE 1200A
HOWELL MI
48843-1002
US

IV. Provider business mailing address

2691 RELIABLE PARKWAY
CHICAGO IL
60686-0026
US

V. Phone/Fax

Practice location:
  • Phone: 517-545-6600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: GARRY C FAJA
Title or Position: PRESIDENT CEO
Credential:
Phone: 734-975-4101