Healthcare Provider Details

I. General information

NPI: 1972710150
Provider Name (Legal Business Name): CAMILLE ROSENBERG P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 10/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 W BIG BEAVER RD SUITE 137
TROY MI
48084-2809
US

IV. Provider business mailing address

3310 W BIG BEAVER RD SUITE 137
TROY MI
48084-2809
US

V. Phone/Fax

Practice location:
  • Phone: 248-792-5200
  • Fax: 249-712-4214
Mailing address:
  • Phone: 248-792-5200
  • Fax: 249-712-4214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601003482
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: