Provider Demographics
NPI:1760610083
Name:FAIRCHILD FAMILY MEDICINE P.C.
Entity Type:Organization
Organization Name:FAIRCHILD FAMILY MEDICINE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIDYANAND
Authorized Official - Middle Name:B
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-949-3064
Mailing Address - Street 1:51086 FAIRCHILD RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-1998
Mailing Address - Country:US
Mailing Address - Phone:586-949-3064
Mailing Address - Fax:586-949-4637
Practice Address - Street 1:51086 FAIRCHILD RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-1998
Practice Address - Country:US
Practice Address - Phone:586-949-3064
Practice Address - Fax:586-949-4637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080E001310OtherBCBS GROUP NUMBER