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General NPI Number Information
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NPI Number | 1881613214
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Entity Type | Organization
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Legal Business Name | WOMEN'S HEALTH SPECIALISTS OF MACOMB COUNTY PC
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 03/08/2011
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Provider Practice Location Address
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Address Line | 16570 19 MILE RD
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City | CLINTON TWP
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State | MI
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Zip | 48038
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Country | US
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Telephone | 586-286-4430
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Fax |
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Provider Business Mailing Address
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Address Line | 16570 19 MILE RD
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City | CLINTON TWP
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State | MI
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Zip | 48038
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Country | US
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Telephone | 586-286-4430
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KEVIN FAHEY
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Credential | MD
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Telephone | 586-286-4430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | KF050703
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License Number State | IL
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