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General NPI Number Information
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NPI Number | 1912200858
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Entity Type | Organization
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Legal Business Name | INDEPENDENT EVALUATION SERVICES
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Dates
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Enumeration Date | 12/15/2010
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Last Update Date | 12/15/2010
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Provider Practice Location Address
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Address Line | 30555 SOUTHFIELD RD. 250
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City | SOUTHFIELD
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State | MI
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Zip | 48076
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Country | US
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Telephone | 248-971-2180
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Fax |
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Provider Business Mailing Address
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Address Line | 30555 SOUTHFIELD RD. 250
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City | SOUTHFIELD
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State | MI
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Zip | 48076
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Country | US
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Telephone | 248-971-2180
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Fax |
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | MS. LEIGH MARIE LIBERATORE
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Credential | B.S.W.
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Telephone | 248-971-2180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 171W00000X
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License Number State | MI
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