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) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | AF036119 | MI | Yes |
| Gastroenterology Physician |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0637997 | Other | MI | BCBS |
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 27, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.