Healthcare Provider Details

I. General information

NPI: 1154378370
Provider Name (Legal Business Name): TSVETI PETROVA MARKOVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 W UNIVERSITY DR SUITE 250
ROCHESTER MI
48307-1871
US

IV. Provider business mailing address

1560 E MAPLE ROAD SUITE 400-CREDENTIALING
TROY MI
48083-1189
US

V. Phone/Fax

Practice location:
  • Phone: 248-650-6301
  • Fax: 248-650-5486
Mailing address:
  • Phone: 248-581-5976
  • Fax: 248-581-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301062127
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: