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General NPI Number Information
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NPI Number | 1568446409
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Entity Type | Organization
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Legal Business Name | DAVENPORT FERGUSON PHYSICIAN GROUP PLLC
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Dates
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Enumeration Date | 12/05/2005
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 15565 NORTHLAND DR SUITE 204
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City | SOUTHFIELD
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State | MI
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Zip | 48075-5310
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Country | US
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Telephone | 248-423-4477
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Fax | 248-423-4488
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Provider Business Mailing Address
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Address Line | 15565 NORTHLAND DR SUITE 204
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City | SOUTHFIELD
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State | MI
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Zip | 48075-5310
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Country | US
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Telephone | 248-423-4477
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Fax | 248-423-4488
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. MARGO KIMBERLEE FERGUSON
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Credential | MD
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Telephone | 248-968-4470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301061334
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License Number State | MI
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