Healthcare Provider Details

I. General information

NPI: 1629286471
Provider Name (Legal Business Name): JANIS SUE KAUFMAN MED, ATR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANIS SUE ROSSMAN MED, ATR

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 WOODWARD AVE
DETROIT MI
48202-2142
US

IV. Provider business mailing address

520 E 5TH ST
ROYAL OAK MI
48067-2849
US

V. Phone/Fax

Practice location:
  • Phone: 313-875-7601
  • Fax:
Mailing address:
  • Phone: 248-543-8164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number05-090
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: