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General NPI Number Information
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NPI Number | 1730379058
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Entity Type | Individual
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Provider Name | RITA CORAM
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Gender | Female
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 07/14/2022
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Provider Practice Location Address
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Address Line | 22060 BEECH ST STE 200
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City | DEARBORN
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State | MI
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Zip | 48124-2853
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Country | US
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Telephone | 313-228-0505
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Fax | 313-228-0506
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Provider Business Mailing Address
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Address Line | 26901 BEAUMONT BLVD STE 3D
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City | SOUTHFIELD
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State | MI
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Zip | 48033-3849
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Country | US
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Telephone | 947-522-1863
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Fax | 947-522-0307
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | TP446
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 41345
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 4301116063
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 4301116063
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License Number State | MI
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