James G Fordyce, MD

Primary specialty

Clinical & Laboratory Immunology (Allergy & Immunology) PhysicianTaxonomy code 207KI0005X

License

4301034472 Issued in MI

Practice address

19855 Outer Dr
Ste 204
Dearborn, MI 48124-2022

Phone

(313) 565-3565

Fax

(313) 565-7723

NPI assigned

Mar 10, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434931200000",
    "number": "1215905765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19855 OUTER DR",
            "address_2": "STE 204",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242022",
            "telephone_number": "313-565-3565",
            "fax_number": "313-565-7723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19855 OUTER DR",
            "address_2": "STE 204",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242022",
            "telephone_number": "313-565-3565",
            "fax_number": "313-565-7723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORDYCE",
        "first_name": "JAMES",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-10",
        "last_updated": "2015-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207KI0005X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Clinical & Laboratory Immunology",
            "state": "MI",
            "license": "4301034472",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0H26340",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1290003",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Allergy & Immunology Physician in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Allergy & Immunology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.