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General NPI Number Information
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NPI Number | 1083738371
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Entity Type | Organization
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Legal Business Name | ROY AND FOWLER ASSOCIATES INC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 880 N FORD BLVD
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City | YPSILANTI
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State | MI
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Zip | 48198-4136
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Country | US
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Telephone | 734-483-9900
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Fax |
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Provider Business Mailing Address
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Address Line | 880 N FORD BLVD
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City | YPSILANTI
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State | MI
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Zip | 48198-4136
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Country | US
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Telephone | 734-483-9900
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Fax |
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | CARL DENNIS FOWLER
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Credential | M.D.
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Telephone | 734-483-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | 810353
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License Number State | MI
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