Healthcare Provider Details

I. General information

NPI: 1093545113
Provider Name (Legal Business Name): NOURA PETROUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/05/2024
Certification Date: 08/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1698 ANDOVER CIR
COMMERCE TOWNSHIP MI
48390-2277
US

IV. Provider business mailing address

1698 ANDOVER CIR
COMMERCE TOWNSHIP MI
48390-2277
US

V. Phone/Fax

Practice location:
  • Phone: 248-421-0100
  • Fax:
Mailing address:
  • Phone: 248-421-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: