Healthcare Provider Details

I. General information

NPI: 1285678730
Provider Name (Legal Business Name): ALITA RENE RICE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 E LONG LAKE RD
BLOOMFIELD HILLS MI
48304-9996
US

IV. Provider business mailing address

51185 NORTHVIEW
PLYMOUTH MI
48170-5169
US

V. Phone/Fax

Practice location:
  • Phone: 248-533-0000
  • Fax:
Mailing address:
  • Phone: 248-396-8096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301053820
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: