NPIMap

Organization Active NPI

Davenport Ferguson Physician Group PLLC

  • Family Medicine Physician
  • Southfield, MI
National Provider Identifier
1568446409
Registry record updated Jun 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301061334 Issued in MI
Legal business name
DAVENPORT FERGUSON PHYSICIAN GROUP PLLC
Practice address
15565 Northland Dr
Suite 204
Southfield, MI 48075-5310
Phone
(248) 423-4477
Fax
(248) 423-4488
NPI assigned
Dec 5, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2008

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

Authorized official

Name
Dr. Margo Kimberlee Ferguson, MDNPI 1881679355
Title
Owner/Physician
Phone
(248) 968-4470

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 4301061334 MI Primary

Addresses

Primary practice location

15565 Northland Dr
Suite 204
Southfield, MI 48075-5310

Mailing address

15565 Northland Dr
Suite 204
Southfield, MI 48075-5310
Phone (248) 423-4477

Other identifiers 3

IdentifierTypeStateIssuer
4495238-10MedicaidMI
080F300760OtherMIBCN
080F300760OtherMIBC GROUP

National Provider Directory

National Provider Directory

Locations

15565 Northland Dr W
Ste 204
Southfield, MI 48075
Phone (248) 423-4477

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1133740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1568446409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15565 NORTHLAND DR",
            "address_2": "SUITE 204",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480755310",
            "telephone_number": "248-423-4477",
            "fax_number": "248-423-4488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15565 NORTHLAND DR",
            "address_2": "SUITE 204",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480755310",
            "telephone_number": "248-423-4477",
            "fax_number": "248-423-4488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVENPORT FERGUSON PHYSICIAN GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-05",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "FERGUSON",
        "authorized_official_first_name": "MARGO",
        "authorized_official_middle_name": "KIMBERLEE",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "248-968-4470",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301061334",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4495238-10",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCN",
            "identifier": "080F300760",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC GROUP",
            "identifier": "080F300760",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; 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.