NPI Code Detail JSON Logo

1053502468 NPI number — EBRAM M FANOUS PT

NPI Number: 1053502468
Health Care Provider/Practitioner: EBRAM M FANOUS PT

Information about “1053502468” NPI (EBRAM M FANOUS PT) exists in 1053502468 in HTML format HTML  |  1053502468 in plain Text format TXT  |  1053502468 in PDF (Portable Document Format) PDF  |  1053502468 in an XML format XML  formats.

NPI Number : 1053502468 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053502468",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FANOUS",
    "FirstName": "EBRAM",
    "MiddleName": "M",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3381 HIDDEN OAKS LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WEST BLOOMFIELD",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48324-3256",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "586-335-8182",
    "MailingAddressFaxNumber": "248-757-2330",
    "FirstLinePracticeLocationAddress": "36430 VAN DYKE AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "STERLING HEIGHTS",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48312-2746",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "586-335-8182",
    "PracticeLocationAddressFaxNumber": "248-757-2330",
    "EnumerationDate": "08/09/2007",
    "LastUpdateDate": "11/05/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": "5501011728",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2025 Data Labs Health. All rights reserved.