Healthcare Provider Details

I. General information

NPI: 1649446725
Provider Name (Legal Business Name): PERINATAL CONSULTATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 GODDARD RD
TAYLOR MI
48180-3926
US

IV. Provider business mailing address

25500 GODDARD RD
TAYLOR MI
48180-3926
US

V. Phone/Fax

Practice location:
  • Phone: 313-299-0966
  • Fax:
Mailing address:
  • Phone: 313-299-0966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRIDGETT ANN CIUPKA
Title or Position: DIRECTOR
Credential:
Phone: 313-299-0966