Provider Demographics
NPI:1417165739
Name:FAULKNER, NEIL E (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:E
Last Name:FAULKNER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5302 TRIPP RD
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:MI
Mailing Address - Zip Code:49287-9620
Mailing Address - Country:US
Mailing Address - Phone:517-431-4891
Mailing Address - Fax:
Practice Address - Street 1:5302 TRIPP RD
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:MI
Practice Address - Zip Code:49287-9620
Practice Address - Country:US
Practice Address - Phone:517-431-4891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082464207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology