Healthcare Provider Details

I. General information

NPI: 1497158968
Provider Name (Legal Business Name): BARBARA ANN KUPFERSCHMIDT CCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31330 SCHOOLCRAFT RD STE 200
LIVONIA MI
48150-2041
US

IV. Provider business mailing address

31330 SCHOOLCRAFT RD STE 200
LIVONIA MI
48150-2041
US

V. Phone/Fax

Practice location:
  • Phone: 734-525-9712
  • Fax:
Mailing address:
  • Phone: 734-525-9712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: