Provider Demographics
NPI:1073504866
Name:FISHBAUGH, PAULA M (MD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:M
Last Name:FISHBAUGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30701 WOODWARD AVE
Mailing Address - Street 2:SUITE S200
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-0987
Mailing Address - Country:US
Mailing Address - Phone:248-584-7600
Mailing Address - Fax:248-584-7606
Practice Address - Street 1:30701 WOODWARD AVE
Practice Address - Street 2:SUITE S200
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0987
Practice Address - Country:US
Practice Address - Phone:248-584-7600
Practice Address - Fax:248-584-7606
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070219207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H47083Medicare UPIN
N20650005Medicare ID - Type Unspecified