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General NPI Number Information
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NPI Number | 1548640709
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Entity Type | Individual
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Provider Name | EMILY O'ROURKE
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Gender | Female
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Dates
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Enumeration Date | 06/03/2015
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Last Update Date | 08/03/2023
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Provider Practice Location Address
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Address Line | 36555 26 MILE ROAD SUITE 1100
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City | LENOX TOWNSHIP
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State | MI
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Zip | 48048
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Country | US
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Telephone | 947-523-4040
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Fax |
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Provider Business Mailing Address
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Address Line | 26901 BEAUMONT BLVD
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City | SOUTHFIELD
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State | MI
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Zip | 48033-3849
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Country | US
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Telephone | 947-522-1848
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601007342
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License Number State | MI
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