Provider Demographics
NPI:1619993680
Name:MICHELLE FURMAGA, M.D., PC
Entity Type:Organization
Organization Name:MICHELLE FURMAGA, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FURMAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-212-0460
Mailing Address - Street 1:35560 GRAND RIVER AVE
Mailing Address - Street 2:#436
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-3123
Mailing Address - Country:US
Mailing Address - Phone:248-212-0460
Mailing Address - Fax:248-679-8868
Practice Address - Street 1:3601 W 13 MILE RD
Practice Address - Street 2:DR. MICHELLE FURMAGA
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6712
Practice Address - Country:US
Practice Address - Phone:248-212-0460
Practice Address - Fax:248-679-8868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0735952084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4940380Medicaid
MI4940380Medicaid