MEDICARE: MS. REBECCA LYNN PREVITI MSPA, PA-C

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	363A00000X	Physician Assistant	5601008805	MI

General Provider Information

NPI Number	:	1154804847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REBECCA LYNN PREVITI MSPA, PA-C

Provider Business Mailing Address
First Line	:	1 FORD PL STE 3A
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-3450
Country	:	US
Telephone Number	:	313-874-4806
Fax Number	:

Provider Business Practice Location Address
First Line	:	6777 W MAPLE RD
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3013
Country	:	US
Telephone Number	:	313-694-0255
Fax Number	:	248-325-0623

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

Provider Enumeration Date	:	09/10/2018
Last Update Date	:	06/01/2026

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