Healthcare Provider Details

I. General information

NPI: 1972689453
Provider Name (Legal Business Name): REPRODUCTIVE MEDICINE ASSOC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 TOWN CENTER DR SUITE 106
TROY MI
48084-1744
US

IV. Provider business mailing address

130 TOWN CENTER DR SUITE 106
TROY MI
48084-1744
US

V. Phone/Fax

Practice location:
  • Phone: 248-619-9030
  • Fax: 248-619-9031
Mailing address:
  • Phone: 248-619-9030
  • Fax: 248-619-9031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. LESLIE A WROLSTAD
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 248-619-3100