Healthcare Provider Details

I. General information

NPI: 1790368322
Provider Name (Legal Business Name): RUCHI AVINASH RACHMALE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2021
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6071 W OUTER DR
DETROIT MI
48235-2624
US

IV. Provider business mailing address

160 CANTERBURY RD
BLOOMFIELD HILLS MI
48304-2916
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-1003
  • Fax:
Mailing address:
  • Phone: 248-798-7862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number4301514797
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: