Healthcare Provider Details

I. General information

NPI: 1649215914
Provider Name (Legal Business Name): NOVI INTERNAL MEDICINE AND PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39475 LEWIS DRIVE STE 130
NOVI MI
48377-2961
US

IV. Provider business mailing address

39475 LEWIS DRIVE STE 130
NOVI MI
48377-2961
US

V. Phone/Fax

Practice location:
  • Phone: 248-374-0502
  • Fax: 248-374-0567
Mailing address:
  • Phone: 248-374-0502
  • Fax: 248-374-0567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL M ROSENBERG
Title or Position: OWNER
Credential: MD
Phone: 248-374-0502