Healthcare Provider Details

I. General information

NPI: 1457569493
Provider Name (Legal Business Name): KATHRYN THERESE BRUCE NATIONALLY CERTIFIED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47100 SCHOENHERR RD STE D
SHELBY TOWNSHIP MI
48315-4714
US

IV. Provider business mailing address

24139 QUAD PARK LN
CLINTON TWP MI
48035-3022
US

V. Phone/Fax

Practice location:
  • Phone: 586-685-0505
  • Fax:
Mailing address:
  • Phone: 586-792-7416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: