Healthcare Provider Details

I. General information

NPI: 1396398681
Provider Name (Legal Business Name): ROCHESTER MEDICAL ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1349 S ROCHESTER RD STE 210
ROCHESTER HILLS MI
48307-3152
US

IV. Provider business mailing address

875 N MICHIGAN AVE FL 31
CHICAGO IL
60611-1962
US

V. Phone/Fax

Practice location:
  • Phone: 248-844-2600
  • Fax:
Mailing address:
  • Phone: 312-794-7730
  • Fax: 312-794-7801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MS. JUSTINE B CORDAY
Title or Position: ADMINISTRATOR
Credential:
Phone: 312-794-7730