Healthcare Provider Details

I. General information

NPI: 1205234697
Provider Name (Legal Business Name): MARGARET FICAJ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2014
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 W HOUGHTON LAKE DR
PRUDENVILLE MI
48651-9613
US

IV. Provider business mailing address

1070 W HOUGHTON LAKE DR
PRUDENVILLE MI
48651-9613
US

V. Phone/Fax

Practice location:
  • Phone: 989-202-4900
  • Fax:
Mailing address:
  • Phone: 989-202-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401000132
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: