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General NPI Number Information
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NPI Number | 1104311604
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Entity Type | Individual
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Provider Name | PEYTON PAUL FAGANEL DO
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Gender | Male
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 04/29/2021
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Provider Practice Location Address
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Address Line | 1675 LEAHY ST STE 201A
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City | MUSKEGON
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State | MI
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Zip | 49442
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Country | US
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Telephone | 231-672-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 32 MEADOWS DR
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City | NORTON SHORES
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State | MI
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Zip | 49444-7786
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Country | US
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Telephone | 319-329-6764
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 92744
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5101024308
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 92744
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License Number State | MT
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