Healthcare Provider Details

I. General information

NPI: 1093861627
Provider Name (Legal Business Name): RODY YEZMAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RODY YEZMAN PH.D.

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29688 TELEGRAPH RD SUITE 400
SOUTHFIELD MI
48034-1362
US

IV. Provider business mailing address

29688 TELEGRAPH RD SUITE 400
SOUTHFIELD MI
48034-1362
US

V. Phone/Fax

Practice location:
  • Phone: 248-354-4422
  • Fax: 248-354-9956
Mailing address:
  • Phone: 248-354-4422
  • Fax: 248-354-9956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301001920
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: