Healthcare Provider Details

I. General information

NPI: 1932396538
Provider Name (Legal Business Name): TONI BALLITCH TRATE DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38215 W 10 MILE RD STE 8
FARMINGTON HILLS MI
48335-2866
US

IV. Provider business mailing address

38215 W 10 MILE RD STE 8
FARMINGTON HILLS MI
48335-2866
US

V. Phone/Fax

Practice location:
  • Phone: 248-474-0955
  • Fax: 248-474-1066
Mailing address:
  • Phone: 248-474-0955
  • Fax: 248-474-1066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DARYL TRATE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 248-819-7486