Individual
DR. PAUL FATELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1510 S STATE RD, DAVISON, MI 48423-1965
(810) 658-9116
(810) 658-2788
Mailing address
1510 S STATE RD, DAVISON, MI 48423-1965
(810) 658-9116
(810) 658-2788
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301006147
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0 B5 4638
BC BS PROVIDER CODE
MI
Enumeration date
03/24/2007
Last updated
11/21/2007
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