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General NPI Number Information
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NPI Number | 1902473432
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Entity Type | Individual
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Provider Name | ALICIA PODORIS
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Gender | Female
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Dates
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Enumeration Date | 06/03/2021
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Last Update Date | 06/03/2021
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Provider Practice Location Address
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Address Line | 150 S MAIN ST
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City | ROCHESTER
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State | MI
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Zip | 48307-2028
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Country | US
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Telephone | 248-710-3303
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Fax |
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Provider Business Mailing Address
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Address Line | 3077 LAKESIDE DR
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City | SHELBY TWP
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State | MI
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Zip | 48316-2957
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Country | US
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Telephone | 760-877-9785
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | MI
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