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General NPI Number Information
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NPI Number | 1295479251
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Entity Type | Organization
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Legal Business Name | COMPASSIONATE GYNECOLOGY OF MICHIGAN PLLC
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Dates
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Enumeration Date | 04/26/2022
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Last Update Date | 04/18/2023
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Provider Practice Location Address
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Address Line | 445 N FENWAY DR
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City | FENTON
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State | MI
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Zip | 48430-2666
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Country | US
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Telephone | 810-869-6086
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Fax | 833-872-0085
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Provider Business Mailing Address
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Address Line | 445 N FENWAY DR
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City | FENTON
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State | MI
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Zip | 48430-2666
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Country | US
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Telephone | 810-869-6086
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Fax | 833-872-0085
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Authorized Official
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Title or Position | OWNER
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Name | MARTINIQUE KLING
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Credential | MD
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Telephone | 989-430-8964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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