Individual provider · NPI-1

Marilynn Ransom Fairfax, MD

Pathology, Clinical Pathology · Detroit, MI

NPI number1962440081
StatusActive
Last updated in NPPESOct 20, 2015

Details

NPI
1962440081
Entity type
Individual (NPI-1)
Name
Marilynn Ransom Fairfax
Credential
MD
Sex
Female
Sole proprietor
No
Enumeration date
Jun 2, 2006
Last updated
Oct 20, 2015

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207ZC0006X Pathology, Clinical Pathology4301058560MIYes
207ZM0300X Pathology, Medical Microbiology4301058560MI

Practice location

4201 St Antoine
Uhc 3c
Detroit, MI 48201-2153

Phone 313-745-4188

Mailing address

1560 E Maple Rd
Suite 400-Credentialing
Troy, MI 48083-1189

Phone 248-581-5974 · Fax 248-581-5640

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