Basic Information
| Provider Information | |||||||||
| NPI: | 1760610083 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAIRCHILD FAMILY MEDICINE P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51086 FAIRCHILD RD | ||||||||
| Address2: | |||||||||
| City: | CHESTERFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480511998 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5869493064 | ||||||||
| FaxNumber: | 5869494637 | ||||||||
| Practice Location | |||||||||
| Address1: | 51086 FAIRCHILD RD | ||||||||
| Address2: | |||||||||
| City: | CHESTERFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480511998 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5869493064 | ||||||||
| FaxNumber: | 5869494637 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2009 | ||||||||
| LastUpdateDate: | 08/31/2009 | ||||||||
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| AuthorizedOfficialLastName: | SINGH | ||||||||
| AuthorizedOfficialFirstName: | VIDYANAND | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5869493064 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080E001310 | 01 | MI | BCBS GROUP NUMBER | OTHER |