David J Fugate PHD PLLC
Organization Active NPI Psychologist · Haslett, MI
NPI 1669511325 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1669511325
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychologist 103T00000X
- License
- 6301006608 (MI)
- Legal business name
- DAVID J FUGATE PHD PLLC
- Practice address
- 1660 Haslett Rd
Suite 1
Haslett, MI 48840-8469 - Phone
- (517) 347-8420
- NPI assigned
- Feb 6, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. David James Fugate, PHD
- Title
- Licensed Psychologist Owner
- Phone
- (517) 347-8420
Practitioners 1
-
David James Fugate, PH.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040420000665 | MI | Part B Supplier - Clinic/Group Practice | 3476548181 |
Receives reassigned benefits from 1 practitioner Practice locations: Haslett, MI |
National Provider Directory
Locations
2248 Mount Hope Rd
#200A
Okemos, MI 48864
Phone (517) 347-8420
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist |
103T00000X | 6301006608 | MI | Yes |
Addresses
Primary practice location
1660 Haslett Rd
Suite 1
Haslett, MI 48840-8469
Mailing address
1660 Haslett Rd
Suite 1
Haslett, MI 48840-8469
Phone (517) 347-8420
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 61-09431 | Other | MI | PHYSICIANS HEALTH PLAN MI |
| P77384 | Other | MI | VALUE OPTIONS BCN |
Other providers in Haslett, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.