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General NPI Number Information
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NPI Number | 1679710008
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Entity Type | Organization
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Legal Business Name | MICHIGAN LIGHT THERAPY PC
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Dates
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Enumeration Date | 01/07/2009
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Last Update Date | 10/19/2009
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Provider Practice Location Address
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Address Line | 1900 SOUTH TELEGRAPH ROAD SUITE 102
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48302-0238
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Country | US
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Telephone | 248-240-0450
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Fax | 248-927-0888
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Provider Business Mailing Address
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Address Line | 1900 SOUTH TELEGRAPH ROAD SUITE 102
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48302-0238
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Country | US
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Telephone | 248-240-0450
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Fax | 248-927-0888
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Authorized Official
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Title or Position | PRESIDENT
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Name | KERI B TOPOUZIAN
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Credential | D.O.
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Telephone | 248-240-0450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 5101008226
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License Number State | MI
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