Provider Demographics
NPI:1235101247
Name:FUGLE AND ASSOCIATES, PC
Entity type:Organization
Organization Name:FUGLE AND ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FUGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-266-2780
Mailing Address - Street 1:1350 W HURON ST
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-3641
Mailing Address - Country:US
Mailing Address - Phone:248-681-4206
Mailing Address - Fax:248-681-5798
Practice Address - Street 1:1350 W HURON ST
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3641
Practice Address - Country:US
Practice Address - Phone:248-681-4206
Practice Address - Fax:248-681-5798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M79640Medicare PIN