Mrs. MICHELLE FANOUS D.O.
Individual Provider (NPI-1)
Active
Emergency Medicine
Provider Information
- NPI Number
1558598292- Provider Type
- Individual Provider (NPI-1)
- Credentials
- D.O.
- Status
- Active
Contact & Location
- Address
- 425 JACK MARTIN BLVD, BRICK, NJ, 087247732
- Phone
- (732) 397-8630
- Fax
- (201) 365-5287
Specialties & Taxonomies
Emergency Medicine
License: PA #OT012883&OS015355
Family Medicine
License: NJ #25MB09538400
Family Medicine
License: PA #OS015355&OT012883
Emergency Medicine
Primary License: NJ #25MB09538400