MEDICARE: JOHN J FATH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0102X	Surgical Critical Care Physician	4301051219	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4301051219	OTHER	MI	CONTROLLED SUSBSTANCE

General Provider Information

NPI Number	:	1013909837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN J FATH MD

Provider Business Mailing Address
First Line	:	3355 GLENDALE AVE
Second Line	:	3RD FLOOR
City	:	TOLEDO
State	:	OH
Zip	:	43614-2426
Country	:	US
Telephone Number	:	419-383-7146
Fax Number	:	419-383-2050

Provider Business Practice Location Address
First Line	:	18101 OAKWOOD BLVD
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-4089
Country	:	US
Telephone Number	:	313-982-5440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	03/07/2023

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Directions to “ JOHN J FATH MD” Practice Location

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