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Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. FANNY AGUIRRE DELA CRUZ M.D. (ADMINISTRATIVE DIRECTOR)
(734) 744-8560
Entity
Organization

Contact information

Practice address
17880 FARMINGTON RD, UNIT B, LIVONIA, MI 48152-3104
(734) 744-8560
(734) 744-8563
Mailing address
17880 FARMINGTON RD, UNIT B, LIVONIA, MI 48152-3104
(734) 744-8560
(734) 744-8563

Taxonomy

Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
36977
MI

Other

Enumeration date
08/04/2008
Last updated
08/06/2014
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