Provider Demographics
NPI:1619013646
Name:FUENTES, FAITH D (MD)
Entity type:Individual
Prefix:MS
First Name:FAITH
Middle Name:D
Last Name:FUENTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4011 ORCHARD DR
Mailing Address - Street 2:SUITE 4012
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6190
Mailing Address - Country:US
Mailing Address - Phone:989-839-2855
Mailing Address - Fax:989-839-7296
Practice Address - Street 1:4011 ORCHARD DR
Practice Address - Street 2:SUITE 4012
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6190
Practice Address - Country:US
Practice Address - Phone:989-839-2855
Practice Address - Fax:989-839-7296
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIFF0549902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2573630Medicaid
E19831Medicare UPIN
0560807Medicare ID - Type Unspecified