Healthcare Provider Details

I. General information

NPI: 1851209407
Provider Name (Legal Business Name): RACHEL BRONFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17320 W 12 MILE ORAD
SOUTHFIELD MI
48237
US

IV. Provider business mailing address

15241 KENTON ST
OAK PARK MI
48237-1553
US

V. Phone/Fax

Practice location:
  • Phone: 248-727-3456
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: