Healthcare Provider Details

I. General information

NPI: 1295946200
Provider Name (Legal Business Name): REBECCA M STUDINGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47601 GRAND RIVER AVE SUITE B129
NOVI MI
48374-1233
US

IV. Provider business mailing address

47601 GRAND RIVER AVE STE B233
NOVI MI
48374-1204
US

V. Phone/Fax

Practice location:
  • Phone: 248-305-8400
  • Fax:
Mailing address:
  • Phone: 248-465-5499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number4301076929
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: