Individual
FALLON FAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3031 W GRAND BLVD, SUITE 450, DETROIT, MI 48202-3046
(313) 346-5235
Mailing address
3031 W GRAND BLVD, SUITE 450, DETROIT, MI 48202-3046
(313) 346-5235
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
S4135
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
MI
Other
Enumeration date
04/05/2016
Last updated
10/06/2020
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