Search › Michigan › 164W00000X
Dajuan Fanning
NPI 1376102434 · on the registry since 2019
Practice
- Address
- 17072 New Hampshire Dr
Southfield, MI 48075 - Phone
- (313) 213-7470
- Clinicians at this address
- 2
Registry record
- Primary taxonomy
- 164W00000X
164W00000X
- Also registered as
- 372500000X
374U00000X
405300000X - Licence states on file
- MI
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2019-06-11
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Michigan