Healthcare Provider Details

I. General information

NPI: 1033780705
Provider Name (Legal Business Name): RUBBY NWONYE RHIT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2021
Last Update Date: 07/05/2021
Certification Date: 07/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24850 GREEN VALLEY ST
SOUTHFIELD MI
48033-3253
US

IV. Provider business mailing address

24850 GREEN VALLEY ST
SOUTHFIELD MI
48033-3253
US

V. Phone/Fax

Practice location:
  • Phone: 248-890-5716
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number218042
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: