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General NPI Number Information
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NPI Number | 1518080126
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Entity Type | Organization
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Legal Business Name | D FERTEL DO PC
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 6149 N WAYNE RD
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City | WESTLAND
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State | MI
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Zip | 48185-7128
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Country | US
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Telephone | 734-728-2130
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Fax |
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Provider Business Mailing Address
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Address Line | 6149 N WAYNE RD
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City | WESTLAND
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State | MI
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Zip | 48185-7128
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Country | US
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Telephone | 734-728-2130
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID J FERTEL
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Credential | D O
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Telephone | 423-310-1642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | DF009690
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License Number State | MI
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