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Individual

MICHAEL K FAIRBANKS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DPM

Contact information

Practice address
425 W BONITA AVE STE 110, SAN DIMAS, CA 91773-2543
(909) 599-0981
Mailing address
425 W BONITA AVE, STE 110, SAN DIMAS, CA 91773-2543
(909) 599-0981

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
E2726
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000E27260
CA
Enumeration date
08/19/2006
Last updated
12/29/2016
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