Healthcare Provider Details

I. General information

NPI: 1770163099
Provider Name (Legal Business Name): KRISTOPHER ANDREW TOROSSIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2021
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 ST. ANTOINE UHC-9C DETROIT MEDICAL CENTER GME OFFICE
DETROIT MI
48201
US

IV. Provider business mailing address

2132 KEYLON DR
WEST BLOOMFIELD MI
48324-1329
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-1020
  • Fax:
Mailing address:
  • Phone: 248-881-7602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4351048269
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: