Provider Demographics
NPI:1477634095
Name:MICHIGAN COMPREHENSIVE FERTILITY CENTER PLLC
Entity Type:Organization
Organization Name:MICHIGAN COMPREHENSIVE FERTILITY CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR,OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGYAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-299-6650
Mailing Address - Street 1:PO BOX 673739
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-3739
Mailing Address - Country:US
Mailing Address - Phone:313-299-6650
Mailing Address - Fax:313-299-6651
Practice Address - Street 1:18181 OAKWOOD BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-5032
Practice Address - Country:US
Practice Address - Phone:313-299-6650
Practice Address - Fax:313-299-6651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDM007496207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI160H229510OtherBCBCM
MI160H229510OtherBCBCM