Healthcare Provider Details

I. General information

NPI: 1013607563
Provider Name (Legal Business Name): MONIKA ASSENOV
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 09/22/2024
Certification Date: 09/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35425 W MICHIGAN AVE
WAYNE MI
48184-9800
US

IV. Provider business mailing address

35425 W MICHIGAN AVE
WAYNE MI
48184-9800
US

V. Phone/Fax

Practice location:
  • Phone: 734-467-7600
  • Fax: 734-467-7636
Mailing address:
  • Phone: 734-467-7600
  • Fax: 734-467-7636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number6802089266
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: