MEDICARE: DR. RITA PAULUS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2901600129	MI

General Provider Information

NPI Number	:	1053972810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RITA PAULUS

Provider Business Mailing Address
First Line	:	4439 PHILIP
Second Line	:
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48382-1480
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 HAGGERTY RD STE 2040
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-2189
Country	:	US
Telephone Number	:	248-624-0008
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2019
Last Update Date	:	06/05/2020

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