Provider Demographics
NPI:1972716777
Name:JAMES J. FAREMOUTH, M.D., P.C.
Entity type:Organization
Organization Name:JAMES J. FAREMOUTH, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FAREMOUTH
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:586-286-0611
Mailing Address - Street 1:43281 COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1110
Mailing Address - Country:US
Mailing Address - Phone:586-286-0611
Mailing Address - Fax:586-228-4713
Practice Address - Street 1:43281 COMMONS DR
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1110
Practice Address - Country:US
Practice Address - Phone:586-286-0611
Practice Address - Fax:586-228-4713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJF029490207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB46966Medicare UPIN
MIOM87560-001Medicare ID - Type Unspecified