Provider Demographics
NPI:1811166762
Name:DEBORA L. FERGUSON, M.D.
Entity type:Organization
Organization Name:DEBORA L. FERGUSON, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DEBORA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-335-1711
Mailing Address - Street 1:43996 WOODWARD AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5028
Mailing Address - Country:US
Mailing Address - Phone:248-335-1711
Mailing Address - Fax:248-335-7950
Practice Address - Street 1:43996 WOODWARD AVE STE 102
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5028
Practice Address - Country:US
Practice Address - Phone:248-335-1711
Practice Address - Fax:248-335-7950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4075952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE77879Medicare UPIN