Healthcare Provider Details

I. General information

NPI: 1528112505
Provider Name (Legal Business Name): RONDA BARAK NORRIS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 TELEGRAPH RD STE H2
BLOOMFIELD HILLS MI
48301-1716
US

IV. Provider business mailing address

6405 TELEGRAPH RD STE H2
BLOOMFIELD HILLS MI
48301-1716
US

V. Phone/Fax

Practice location:
  • Phone: 248-647-1200
  • Fax: 248-647-1329
Mailing address:
  • Phone: 248-647-1200
  • Fax: 248-647-1329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberRB053101
License Number StateMI

VIII. Authorized Official

Name: DR. RONDA BARAK NORRIS
Title or Position: PRESIDENT
Credential: MD
Phone: 248-647-1200