Dr. Evan Bradley Fonger
Family Doctor Family Doctor - Hospice and Palliative Medicine
400 Mack Avenue
Detroit
, Michigan 48201
Dr. Evan Bradley Fonger
Family Doctor Family Doctor - Hospice and Palliative Medicine
400 Mack Avenue
Detroit
, Michigan 48201
(313) 578-6379
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About
Features
Specialties
- Family Doctor
- Family Doctor - Hospice and Palliative Medicine
Languages spoken
- English
Location
First Address
- Dr. Evan Bradley Fonger
- 400 Mack Avenue
- Detroit, MI
- Zip : 48201
- Fax : (313) 578-6379
- Phone : (313) 578-5000
Second Address
- Dr. Evan Bradley Fonger
- 400 Mack Avenue
- Detroit, MI
- Zip : 48201
- Fax : (313) 578-6379
- Phone : (313) 578-5000
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207Q00000X | Family Doctor | 4301087817 | MI |
| N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 4301087817 | MI |
National Provider Identifier
| NPI | 1467655886 |
|---|---|
| Provider Name | Dr. Evan Bradley Fonger |
| First Address | Detroit, MI 48201 |
| Second Address | Detroit, MI 48201 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 06/06/2007 |
| Last Update Date | 16/04/2019 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.