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General NPI Number Information
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NPI Number | 1578505129
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Entity Type | Organization
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Legal Business Name | HEARTFELT PHYSICIAN SERVICES, PLLC
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 12/18/2020
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Provider Practice Location Address
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Address Line | 20245 W 12 MILE RD STE 120
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City | SOUTHFIELD
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State | MI
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Zip | 48076-5409
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Country | US
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Telephone | 248-552-1327
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Fax | 586-859-5729
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Provider Business Mailing Address
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Address Line | 20245 W 12 MILE RD STE 120
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City | SOUTHFIELD
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State | MI
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Zip | 48076-5409
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Country | US
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Telephone | 248-552-1327
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Fax | 586-859-5729
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. REBECCA KATHLEENE MOTLEY
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Credential | MD
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Telephone | 248-552-1327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 4301407599
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License Number State | MI
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