Healthcare Provider Details

I. General information

NPI: 1013772573
Provider Name (Legal Business Name): XIYU CAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 WOODWARD AVE FL 2
DETROIT MI
48201-2027
US

IV. Provider business mailing address

2500 NORMANDY RD UNIT 52
ROYAL OAK MI
48073-1883
US

V. Phone/Fax

Practice location:
  • Phone: 313-656-4052
  • Fax:
Mailing address:
  • Phone: 734-834-9845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6362009726
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: