Provider Demographics
NPI:1205680501
Name:FAVORS, FREDDIE JR
Entity type:Individual
Prefix:MR
First Name:FREDDIE
Middle Name:
Last Name:FAVORS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27200 FRANKLIN RD APT 603
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-2348
Mailing Address - Country:US
Mailing Address - Phone:313-854-2450
Mailing Address - Fax:
Practice Address - Street 1:27200 FRANKLIN RD APT 603
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-2348
Practice Address - Country:US
Practice Address - Phone:313-854-2450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider