Healthcare Provider Details

I. General information

NPI: 1588601975
Provider Name (Legal Business Name): VESNA LUCIYA ROI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18325 E 10 MILE RD STE. 100
ROSEVILLE MI
48066-4990
US

IV. Provider business mailing address

18325 E 10 MILE RD STE. 100
ROSEVILLE MI
48066-4990
US

V. Phone/Fax

Practice location:
  • Phone: 586-776-1010
  • Fax: 586-776-0364
Mailing address:
  • Phone: 586-776-1010
  • Fax: 586-776-0364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101011687
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: