Anthony G Fabaz, D.O.

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

5101006766 Issued in MI

Practice address

5 N Atkinson Dr
Suite 304
Ludington, MI 49431-2918

Phone

(231) 843-2600

Fax

(231) 843-2665

NPI assigned

Dec 18, 2006

Last updated

Aug 23, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Lakeshore Vein &Laser Clinic PLLC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Ludington, MI
  • NPI 1083753479
  NPD (past) Authorized official
• Memorial Medical Center of West Michigan

  dba Corewell Health Ludington Hospital

  • General Acute Care Hospital
  • Ludington, MI
  • NPI 1972589489
  NPD (past)

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314057600000",
    "number": "1568525764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 N ATKINSON DR STE 304",
            "city": "LUDINGTON",
            "state": "MI",
            "postal_code": "494312918",
            "telephone_number": "231-843-2600",
            "fax_number": "231-843-2665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 N ATKINSON DR",
            "address_2": "SUITE 304",
            "city": "LUDINGTON",
            "state": "MI",
            "postal_code": "494312918",
            "telephone_number": "231-843-2600",
            "fax_number": "231-843-2665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FABAZ",
        "first_name": "ANTHONY",
        "middle_name": "G",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-18",
        "last_updated": "2011-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MI",
            "license": "5101006766",
            "primary": true
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "MI",
            "license": "AF006766",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven L. Early, NP
• Wendy V Early, OTR/L
• Jane Louise Ehler, LBSW
• Erica D Ek, PSYD
• Charles Christopher Eldredge, LLP
• Angela Johnson Faber, CNM
• Nicholas Failer, DPT
• Carrie C Failor, MA, CCC-SLP
• Derek Frederick Fatura, O.D.
• Susan S Filter, LMSW

• Vascular Surgery Physician in Ludington, MI
• Providers in Ludington, MI by specialty
• Vascular Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2011; 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.