Healthcare Provider Details

I. General information

NPI: 1891453684
Provider Name (Legal Business Name): RVLWF MICHIGAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42450 W 12 MILE RD STE 105
NOVI MI
48377-3011
US

IV. Provider business mailing address

10608 FLICKENGER LN
KNOXVILLE TN
37922-3485
US

V. Phone/Fax

Practice location:
  • Phone: 248-970-1340
  • Fax: 833-673-0185
Mailing address:
  • Phone: 865-392-6262
  • Fax: 865-674-5089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN WALKER
Title or Position: CEO
Credential: APRN CRNA
Phone: 865-392-6262