Healthcare Provider Details

I. General information

NPI: 1932214988
Provider Name (Legal Business Name): KREIL AND ROCHEFORT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22074 MICHIGAN AVE
DEARBORN MI
48124-2353
US

IV. Provider business mailing address

22074 MICHIGAN AVE
DEARBORN MI
48124-2353
US

V. Phone/Fax

Practice location:
  • Phone: 313-565-9510
  • Fax: 313-565-4410
Mailing address:
  • Phone: 313-565-9510
  • Fax: 313-565-4410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberBR066005
License Number StateMI

VIII. Authorized Official

Name: DR. BRUCE JOHN ROCHEFORT
Title or Position: OWNER
Credential: MD
Phone: 313-565-9510