Healthcare Provider Details

I. General information

NPI: 1558939942
Provider Name (Legal Business Name): REBECCA ANN LOECHLI PISAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39200 GARFIELD RD STE B
CLINTON TOWNSHIP MI
48038-4095
US

IV. Provider business mailing address

1345 MARTIN CT APT 226
BETHLEHEM PA
18018-2562
US

V. Phone/Fax

Practice location:
  • Phone: 586-286-6060
  • Fax: 833-985-2155
Mailing address:
  • Phone: 734-660-8989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301513935
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: