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General NPI Number Information
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NPI Number | 1700181211
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Entity Type | Organization
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Legal Business Name | TRACEY TOROSIAN, PH.D., PLLC
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Dates
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Enumeration Date | 01/13/2011
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Last Update Date | 01/13/2011
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Provider Practice Location Address
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Address Line | 20816 E 11 MILE RD SUITE 112
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-1565
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Country | US
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Telephone | 586-774-7344
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Fax | 586-774-7345
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Provider Business Mailing Address
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Address Line | 20816 E 11 MILE RD SUITE 112
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-1565
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Country | US
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Telephone | 586-774-7344
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Fax | 586-774-7345
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | TRACEY TOROSIAN
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Credential | PH.D.
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Telephone | 586-774-7344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 6301009014
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License Number State | MI
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