Healthcare Provider Details

I. General information

NPI: 1104240175
Provider Name (Legal Business Name): ADRIAN EMERICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20303 KELLY RD
DETROIT MI
48225-1206
US

IV. Provider business mailing address

2900 CONNER ST BUILDING A
DETROIT MI
48215-2407
US

V. Phone/Fax

Practice location:
  • Phone: 313-245-7000
  • Fax:
Mailing address:
  • Phone: 313-308-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401014101
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: