Healthcare Provider Details

I. General information

NPI: 1336769793
Provider Name (Legal Business Name): EMMA LYNN TRENTACOSTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMMA LYNN HERRMAN MD

II. Dates (important events)

Enumeration Date: 04/25/2020
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44344 DEQUINDRE RD STE 260
STERLING HEIGHTS MI
48314-1040
US

IV. Provider business mailing address

44344 DEQUINDRE RD STE 260
STERLING HEIGHTS MI
48314-1040
US

V. Phone/Fax

Practice location:
  • Phone: 586-323-1500
  • Fax:
Mailing address:
  • Phone: 586-323-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number4351046220
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: