Healthcare Provider Details

I. General information

NPI: 1932289618
Provider Name (Legal Business Name): MITCHELL FOLBE M D P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E LONG LK RD
TROY MI
48085
US

IV. Provider business mailing address

115 E LONG LK RD
TROY MI
48085
US

V. Phone/Fax

Practice location:
  • Phone: 248-879-2500
  • Fax: 248-813-6511
Mailing address:
  • Phone: 248-879-2500
  • Fax: 248-813-6511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberLT072320
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMF059575
License Number StateMI

VIII. Authorized Official

Name: MITCHELL FOLBE
Title or Position: PRESIDENT
Credential: MD
Phone: 248-879-2500