Healthcare Provider Details

I. General information

NPI: 1710566310
Provider Name (Legal Business Name): FAIRFIELD PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 05/16/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3106 S WAYNE RD
WAYNE MI
48184-1221
US

IV. Provider business mailing address

3106 S WAYNE RD
WAYNE MI
48184-1221
US

V. Phone/Fax

Practice location:
  • Phone: 734-351-3166
  • Fax: 734-309-7700
Mailing address:
  • Phone: 734-351-3166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. OLUFUNKE ADEYEMO
Title or Position: OWNER
Credential: MD
Phone: 734-351-3166