Michael B Fairbanks, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MF051895 Issued in MI

Practice address

205 S Bradley Hwy
Rogers City, MI 49779-2137

Phone

(989) 734-2052

Fax

(989) 734-7390

NPI assigned

May 26, 2006

Last updated

Feb 23, 2010By the provider in NPPES

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 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Thunder Bay Community Health Service, Inc

  • Federally Qualified Health Center (FQHC)
  • Rogers City, MI
  • NPI 1477591691
  NPD (past)
• Thunder Bay Community Health Service, Inc

  • Federally Qualified Health Center (FQHC)
  • Onaway, MI
  • NPI 1508804246
  NPD (past)
• Central Kentucky Emergency Services P.S.C.

  • Emergency Medicine Physician
  • Shelbyville, KY
  • NPI 1497750194
  NPD (past)

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266883200000",
    "number": "1447206776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 427",
            "city": "HILLMAN",
            "state": "MI",
            "postal_code": "497460427",
            "telephone_number": "989-742-4583",
            "fax_number": "989-742-4298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 S BRADLEY HWY",
            "city": "ROGERS CITY",
            "state": "MI",
            "postal_code": "497792137",
            "telephone_number": "989-734-2052",
            "fax_number": "989-734-7390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRBANKS",
        "first_name": "MICHAEL",
        "middle_name": "B",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-26",
        "last_updated": "2010-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "MF051895",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4134559",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4888306",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE BILL PAY TO",
            "identifier": "0F060160",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4134568",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4134577",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shelby M Carrier, M.A. CCC-SLP
• Charisse Suszek
• Messiah Cheeran, R.PH
• Emilie P Cline
• Austin Fairbanks
• Russell Austin Fairbanks, D.C.
• Meagan Elayn Florip, LMSW
• FMG North Bradley Highway Michigan LLC (Tendercare Health Center - Rogers City)
• Gajewski Inc
• Gajewski Inc (McLean Pharmacy)

• Family Medicine Physician in Rogers City, MI
• Providers in Rogers City, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2010; 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.