Healthcare Provider Details

I. General information

NPI: 1912200858
Provider Name (Legal Business Name): INDEPENDENT EVALUATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2010
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30555 SOUTHFIELD RD. 250
SOUTHFIELD MI
48076
US

IV. Provider business mailing address

30555 SOUTHFIELD RD. 250
SOUTHFIELD MI
48076
US

V. Phone/Fax

Practice location:
  • Phone: 248-971-2180
  • Fax:
Mailing address:
  • Phone: 248-971-2180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number171W00000X
License Number StateMI

VIII. Authorized Official

Name: MS. LEIGH MARIE LIBERATORE
Title or Position: CLINIC MANAGER
Credential: B.S.W.
Phone: 248-971-2180