Healthcare Provider Details

I. General information

NPI: 1831485127
Provider Name (Legal Business Name): MS. BALTENIA HURT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7529 W PARKWAY ST
REDFORD MI
48239-1095
US

IV. Provider business mailing address

7529 W PARKWAY
REDFORD MICHIGAN
48239
UM

V. Phone/Fax

Practice location:
  • Phone: 313-359-9382
  • Fax:
Mailing address:
  • Phone: 313-359-9382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number174400000X
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: