Healthcare Provider Details

I. General information

NPI: 1740911486
Provider Name (Legal Business Name): FAITH STEWART-YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24887 GODDARD RD
TAYLOR MI
48180-3930
US

IV. Provider business mailing address

24887 GODDARD RD
TAYLOR MI
48180-3930
US

V. Phone/Fax

Practice location:
  • Phone: 734-946-7200
  • Fax:
Mailing address:
  • Phone: 734-946-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601011829
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: