A.W.C. Fairclough MD PC

Organization Active NPI Internal Medicine Physician · Pontiac, MI

NPI 1104144526 · NPPES record last updated Jul 27, 2010

Key facts

NPI
1104144526
Entity type
Organization (NPI type 2)
Primary specialty
Internal Medicine Physician 207R00000X
License
AF036119 (MI)
Legal business name
A.W.C. FAIRCLOUGH MD PC
Practice address
989 University Dr
Suite 107
Pontiac, MI 48342-1885
Phone
(248) 334-4773
Fax
(248) 334-8230
NPI assigned
May 10, 2010
Organization subpart
No

Authorized official

Name
Dr. Anthony Fariclough, MD
Title
President
Phone
(248) 334-4773

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP
207R00000X AF036119 MI Yes
Gastroenterology Physician
Group: 193200000X MULTI-SPECIALTY GROUP
207RG0100X AF036119 MI

Addresses

Primary practice location

989 University Dr
Suite 107
Pontiac, MI 48342-1885

Mailing address

989 University Dr
Suite 107
Pontiac, MI 48342-1885
Phone (248) 334-4773

Other identifiers

IdentifierTypeStateIssuer
0637997OtherMIBCBS

Other providers in Pontiac, MI

All providers in Pontiac, MI · Internal Medicine Physician in Michigan

Sources for this page

Verify at the official NPI Registry.