Healthcare Provider Details

I. General information

NPI: 1285605774
Provider Name (Legal Business Name): BRUCE TERRIO MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12675 WHALEN LAKE DR
HARTLAND MI
48353-1513
US

IV. Provider business mailing address

PO BOX 67000 DEPT 291701
DETROIT MI
48267-0002
US

V. Phone/Fax

Practice location:
  • Phone: 248-347-8191
  • Fax: 440-934-6147
Mailing address:
  • Phone: 248-347-8191
  • Fax: 440-934-6147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRUCE W TERRIO
Title or Position: OWNER
Credential:
Phone: 248-496-0927