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NPI Code Detail

MEDICARE: CIRA MICHIGAN PC

MEDICARE: CIRA MICHIGAN PC
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
12085R0202XDiagnostic Radiology Physician

General Provider Information

NPI Number : 1972141513
Entity Type Code : Organization
Provider Name (Legal Business Name) : CIRA MICHIGAN PC
Provider Business Mailing Address
First Line : 111 OAKWOOD RD
Second Line :
City : EAST PEORIA
State : IL
Zip : 61611-1853
Country : US
Telephone Number : 309-740-4272
Fax Number :
Provider Business Practice Location Address
First Line : 3401 LUDINGTON ST
Second Line :
City : ESCANABA
State : MI
Zip : 49829-1300
Country : US
Telephone Number : 906-786-3311
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. KEVIN M FAHEY
Credential : MD
Telephone Number : 309-740-4272
Provider Enumeration Date : 12/13/2019
Last Update Date : 03/10/2026

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Directions to “CIRA MICHIGAN PC ” Practice Location

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