Basic Information
| Provider Information | |||||||||
| NPI: | 1790780864 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERGUSON | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30400 TELEGRAPH ROAD | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | BINGHAM FARMS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480255814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483539460 | ||||||||
| FaxNumber: | 2483538084 | ||||||||
| Practice Location | |||||||||
| Address1: | 30400 TELEGRAPH RD | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | BINGHAM FARMS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480254537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483539460 | ||||||||
| FaxNumber: | 2483538084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 09/22/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 4301057411 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 160F376930 | 01 | MI | BCBS OF MI FEDERAL EMPLOY | OTHER | 160F376930 | 01 | MI | BCN ADVANTAGE | OTHER | 160F376930 | 01 | MI | BCBS OF MICHIGAN | OTHER | F29822 | 01 | MI | HEALTH ALLIANCE PLAN | OTHER | 382279274 | 01 | MI | ALL COMMERCIALS | OTHER | 4620480 | 05 | MI | MEDICAID | C6330 | 01 | MI | MCARE | OTHER | 160F376930 | 01 | MI | BLUE CARE NETWORK | OTHER | 0F37693007 | 01 | MI | MEDICARE PLUS BLUE | OTHER |