Healthcare Provider Details

I. General information

NPI: 1992361935
Provider Name (Legal Business Name): ERICA PREBLICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36475 FIVE MILE RD
LIVONIA MI
48154-1971
US

IV. Provider business mailing address

1605 WOODBROOK ST APT 115
EAST LANSING MI
48823-1742
US

V. Phone/Fax

Practice location:
  • Phone: 734-655-4800
  • Fax:
Mailing address:
  • Phone: 734-366-0934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5951001568
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: