Individual
MARILYNN RANSOM FAIRFAX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4201 ST ANTOINE, UHC 3C, DETROIT, MI 48201-2153
(313) 745-4188
Mailing address
1560 E MAPLE RD, SUITE 400-CREDENTIALING, TROY, MI 48083-1189
(248) 581-5974
(248) 581-5640
Taxonomy
Speciality
Code
Description
License number
State
207ZC0006X
Clinical Pathology Physician
Primary
4301058560
MI
207ZM0300X
Medical Microbiology Physician
4301058560
MI
Other
Enumeration date
06/02/2006
Last updated
10/20/2015
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