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General NPI Number Information
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NPI Number | 1720583966
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Entity Type | Individual
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Provider Name | SAMANTHA CASSIE GBUR MS, CGC
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Gender | Female
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Dates
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Enumeration Date | 03/29/2018
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | 3601 W 13 MILE RD 2 SOUTH TOWER-FETAL IMAGING/GENETICS
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City | ROYAL OAK
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State | MI
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Zip | 48073-6712
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Country | US
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Telephone | 248-898-9238
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Fax |
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Provider Business Mailing Address
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Address Line | 75 FRANCIS ST
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City | BOSTON
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State | MA
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Zip | 02115-6110
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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 | 17399
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License Number State | MA
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