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NPI Code Detail

MEDICARE: MR. MICHAEL A FABBRI AT, ATC

MEDICARE: MR. MICHAEL A FABBRI AT, ATC
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
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1982618773
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL A FABBRI AT, ATC
Provider Business Mailing Address
First Line : 2104 CHESTNUT CIR
Second Line :
City : LAKE ORION
State : MI
Zip : 48360-2279
Country : US
Telephone Number : 248-393-2838
Fax Number :
Provider Business Practice Location Address
First Line : 6525 2ND AVE
Second Line :
City : DETROIT
State : MI
Zip : 48202-3006
Country : US
Telephone Number : 313-972-4137
Fax Number : 313-972-4134
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2006
Last Update Date : 04/25/2011

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