Provider Demographics
NPI:1790780864
Name:FERGUSON, PATRICIA ANN (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30400 TELEGRAPH ROAD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5814
Mailing Address - Country:US
Mailing Address - Phone:248-353-9460
Mailing Address - Fax:248-353-8084
Practice Address - Street 1:30400 TELEGRAPH RD
Practice Address - Street 2:SUITE 350
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4537
Practice Address - Country:US
Practice Address - Phone:248-353-9460
Practice Address - Fax:248-353-8084
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057411207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI160F376930OtherBCBS OF MI FEDERAL EMPLOY
MI160F376930OtherBCN ADVANTAGE
MI160F376930OtherBCBS OF MICHIGAN
MIF29822OtherHEALTH ALLIANCE PLAN
MI382279274OtherALL COMMERCIALS
MI4620480Medicaid
MIC6330OtherMCARE
MI160F376930OtherBLUE CARE NETWORK
MI0F37693007OtherMEDICARE PLUS BLUE
MIC6330OtherMCARE
MI0737693007Medicare ID - Type Unspecified