| Doctor Name: | MOISES FAJARDO |
| NPI Number: | 1740683069 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 4704267838 |
| Business Practice Address: | 1402 W 14 Mile Rd Clawson, MI - 480171499 |
| Business Phone Number: | 8663892727 |
| Business Fax Number: | |
| Mailing Address: | 2445 Claymont Dr, TROY |
| State: | MI |
| Postal Code: | 480982493 |
| Phone Number: | 2487927114 |
| Fax Number: | |
| NPI Enumeration Date: | 10/01/2014 |
| NPI Last Update Date: | 02/17/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 4704267838 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |