Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 4301102424 | MI |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 4301102424 | MI |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | MD457367 | PA |
NPI | 1801020920 |
---|---|
Provider Name | Pamela Susan Fairchild |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48103-6201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2009 |
Last Update Date | 05/02/2020 |