Healthcare Provider Details

I. General information

NPI: 1972032423
Provider Name (Legal Business Name): RACHEL ROSE SANTORO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16836 NEWBURGH RD
LIVONIA MI
48154-1600
US

IV. Provider business mailing address

1935 PAULINE BLVD STE 200
ANN ARBOR MI
48103-5048
US

V. Phone/Fax

Practice location:
  • Phone: 734-464-4220
  • Fax:
Mailing address:
  • Phone: 734-215-7931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4301500708
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: