Healthcare Provider Details

I. General information

NPI: 1861608127
Provider Name (Legal Business Name): PHYSICIANS ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W GREENLAWN AVE
LANSING MI
48910-2819
US

IV. Provider business mailing address

1031 E SAGINAW ST
LANSING MI
48906-5519
US

V. Phone/Fax

Practice location:
  • Phone: 517-487-1288
  • Fax: 517-487-1129
Mailing address:
  • Phone: 517-487-1288
  • Fax: 517-487-1129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN G FATA
Title or Position: PRESIDENT
Credential: MD
Phone: 517-487-1288