Individual
MOISES FAJARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1402 W 14 MILE RD, CLAWSON, MI 48017-1499
(866) 389-2727
Mailing address
2445 CLAYMONT DR, TROY, MI 48098-2493
(248) 792-7114
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704267838
MI
363LF0000X
Family Nurse Practitioner
4704267838
MI
Other
Enumeration date
10/01/2014
Last updated
10/22/2020
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