Provider Demographics
NPI:1780876037
Name:CATHERINE MCAULEY HEALTH SERVICES
Entity type:Organization
Organization Name:CATHERINE MCAULEY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FAJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-975-4101
Mailing Address - Street 1:5800 N LILLEY RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3668
Mailing Address - Country:US
Mailing Address - Phone:734-981-2400
Mailing Address - Fax:
Practice Address - Street 1:5800 N LILLEY RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3668
Practice Address - Country:US
Practice Address - Phone:734-981-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTSIDE OB/ GYN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H11068OtherBCBS BCN
MI0M78840OtherMEDICARE GROUP NUMBER