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General NPI Number Information
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NPI Number | 1972141513
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Entity Type | Organization
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Legal Business Name | CIRA MICHIGAN, P.C.
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Dates
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Enumeration Date | 12/13/2019
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Last Update Date | 12/13/2019
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Provider Practice Location Address
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Address Line | 3401 LUDINGTON ST
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City | ESCANABA
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State | MI
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Zip | 49829-1300
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Country | US
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Telephone | 906-786-3311
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Fax |
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Provider Business Mailing Address
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Address Line | 111 OAKWOOD RD
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City | EAST PEORIA
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State | IL
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Zip | 61611-1853
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Country | US
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Telephone | 309-740-4272
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN M FAHEY
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Credential | MD
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Telephone | 309-740-4272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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