Provider Demographics
NPI:1457092033
Name:PETER FARAGO MEDICINE, PLLC
Entity Type:Organization
Organization Name:PETER FARAGO MEDICINE, PLLC
Other - Org Name:AEGIS MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:FARAGO
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:888-849-1080
Mailing Address - Street 1:17888 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230-6234
Mailing Address - Country:US
Mailing Address - Phone:888-849-1080
Mailing Address - Fax:
Practice Address - Street 1:17888 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48230-6234
Practice Address - Country:US
Practice Address - Phone:888-849-1080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-06
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty