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General NPI Number Information
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NPI Number | 1861994592
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Entity Type | Organization
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Legal Business Name | FARWELL INTERNAL MEDICINE PLLC
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Dates
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Enumeration Date | 03/08/2018
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Last Update Date | 10/21/2018
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Provider Practice Location Address
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Address Line | 522 E MAIN ST
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City | FARWELL
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State | MI
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Zip | 48622-9118
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Country | US
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Telephone | 407-288-4140
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Fax |
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Provider Business Mailing Address
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Address Line | 522 E MAIN ST
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City | FARWELL
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State | MI
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Zip | 48622-9118
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Country | US
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Telephone | 989-544-4226
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRENDA NYAMOGO
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Credential | MD
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Telephone | 989-544-4226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301111706
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License Number State | MI
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