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General NPI Number Information
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NPI Number | 1104106020
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Entity Type | Organization
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Legal Business Name | RICHARD F AMBROSE JR DPM PC
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Dates
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Enumeration Date | 08/23/2011
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Last Update Date | 08/23/2011
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Provider Practice Location Address
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Address Line | 415 MILL RD
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City | ADRIAN
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State | MI
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Zip | 49221-1764
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Country | US
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Telephone | 517-263-0427
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Fax |
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Provider Business Mailing Address
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Address Line | 16170 FRANKLIN RD
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City | NORTHVILLE
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State | MI
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Zip | 48168-9515
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Country | US
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Telephone | 734-425-4000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD AMBROSE JR.
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Credential | D.P.M.
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Telephone | 734-425-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 5901001007
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License Number State | MI
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