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General NPI Number Information
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NPI Number | 1629335252
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Entity Type | Individual
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Provider Name | PREETHI PREMKUMAR CGC
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Gender | Female
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Dates
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Enumeration Date | 04/20/2012
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Last Update Date | 04/20/2012
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Provider Practice Location Address
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Address Line | 44405 WOODWARD AVE # 4WEST
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City | PONTIAC
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State | MI
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Zip | 48341-5023
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Country | US
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Telephone | 248-858-6487
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Fax | 248-858-3648
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Provider Business Mailing Address
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Address Line | 695 PLUM RIDGE DR
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City | ROCHESTER HILLS
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State | MI
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Zip | 48309-1021
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Country | US
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Telephone |
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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 | 170300000X
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Taxonomy Name | Genetic Counselor (M.S.)
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License Number |
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License Number State |
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