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General NPI Number Information
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NPI Number | 1598971327
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Entity Type | Individual
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Provider Name | AMY PHILOMENA DEROSA D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 33200 W 14 MILE RD STE 180
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3587
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Country | US
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Telephone | 248-688-7597
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Fax | 248-498-6060
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Provider Business Mailing Address
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Address Line | 33200 W 14 MILE RD STE 180
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3587
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Country | US
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Telephone | 248-688-7597
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Fax | 248-498-6060
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 5101017043
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 5101017043
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 5101017043
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License Number State | MI
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