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General NPI Number Information
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NPI Number | 1457569493
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Entity Type | Individual
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Provider Name | KATHRYN THERESE BRUCE NATIONALLY CERTIFIED
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Gender | Female
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 47100 SCHOENHERR RD STE D
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48315-4714
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Country | US
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Telephone | 586-685-0505
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Fax |
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Provider Business Mailing Address
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Address Line | 24139 QUAD PARK LN
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City | CLINTON TWP
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State | MI
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Zip | 48035-3022
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Country | US
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Telephone | 586-792-7416
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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