Healthcare Provider Details

I. General information

NPI: 1821312281
Provider Name (Legal Business Name): DAVID F PAUL OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12415 E 12 MILE ROAD
WARREN MI
48093-3586
US

IV. Provider business mailing address

12415 E 12 MILE RD
WARREN MI
48093-3586
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-4477
  • Fax: 586-573-0305
Mailing address:
  • Phone: 586-573-4477
  • Fax: 586-573-0305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number4901002487
License Number StateMI

VIII. Authorized Official

Name: DAVID F PAUL
Title or Position: OWNER
Credential: .O.D.
Phone: 586-573-4477