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General NPI Number Information
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NPI Number | 1790018315
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Entity Type | Organization
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Legal Business Name | BAYSIDE FAMILY MEDICINE CHESTERFIELD PC
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Dates
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Enumeration Date | 09/14/2009
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Last Update Date | 09/14/2009
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Provider Practice Location Address
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Address Line | 31225 23 MILE RD
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City | CHESTERFIELD
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State | MI
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Zip | 48047-1848
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Country | US
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Telephone | 586-598-2900
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Fax | 586-598-2905
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Provider Business Mailing Address
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Address Line | 31225 23 MILE RD
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City | CHESTERFIELD
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State | MI
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Zip | 48047-1848
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Country | US
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Telephone | 586-598-2900
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Fax | 586-598-2905
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KATHLEEN ANN RHEAUME
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Credential | MD
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Telephone | 586-598-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301058573
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License Number State | MI
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