Healthcare Provider Details

I. General information

NPI: 1528508850
Provider Name (Legal Business Name): CHRISTINE MARIE PLICHTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21000 E 12 MILE RD STE 112
SAINT CLAIR SHORES MI
48081-1156
US

IV. Provider business mailing address

1950 S ROCHESTER RD # 1083
ROCHESTER HILLS MI
48307-3534
US

V. Phone/Fax

Practice location:
  • Phone: 586-772-5550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101025868
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: