Healthcare Provider Details

I. General information

NPI: 1417728288
Provider Name (Legal Business Name): RITA EZEH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W 13 MILE RD
MADISON HEIGHTS MI
48071-1873
US

IV. Provider business mailing address

3501 INVERNESS DR
ROCHESTER HILLS MI
48306-4757
US

V. Phone/Fax

Practice location:
  • Phone: 248-298-1000
  • Fax: 248-298-1006
Mailing address:
  • Phone: 860-910-7772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704325978
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: