Healthcare Provider Details

I. General information

NPI: 1831127828
Provider Name (Legal Business Name): MICHAEL J FAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 3RD ST S
GLASGOW MT
59230-2604
US

IV. Provider business mailing address

621 3RD ST S
GLASGOW MT
59230-2604
US

V. Phone/Fax

Practice location:
  • Phone: 406-228-4331
  • Fax: 406-228-9539
Mailing address:
  • Phone: 406-228-4331
  • Fax: 406-228-9539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number6963
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: