Healthcare Provider Details

I. General information

NPI: 1326615840
Provider Name (Legal Business Name): RINA LEAH NATHANSON D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RINA LEAH EDELSON D.O

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 10/08/2024
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31500 TELEGRAPH RD STE 105
BINGHAM FARMS MI
48025
US

IV. Provider business mailing address

31500 TELEGRAPH RD STE 105
BINGHAM FARMS MI
48025
US

V. Phone/Fax

Practice location:
  • Phone: 248-540-8700
  • Fax: 248-540-8701
Mailing address:
  • Phone: 248-540-8700
  • Fax: 248-540-8701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101028249
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5151015161
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: