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NPI Code Detail

MEDICARE: MS. BEVERLY SUSAN PRICE RD

MEDICARE:  MS. BEVERLY SUSAN PRICE  RD
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
1133V00000XRegistered Dietitian681872MI

General Provider Information

NPI Number : 1528290764
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BEVERLY SUSAN PRICE RD
Provider Business Mailing Address
First Line : 13123 HART AVE
Second Line :
City : HUNTINGTON WOODS
State : MI
Zip : 48070-1010
Country : US
Telephone Number : 248-390-4150
Fax Number :
Provider Business Practice Location Address
First Line : 441 S LIVERNOIS RD STE 100
Second Line :
City : ROCHESTER HILLS
State : MI
Zip : 48307-2585
Country : US
Telephone Number : 248-608-8800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2009
Last Update Date : 11/21/2022

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Directions to “ MS. BEVERLY SUSAN PRICE RD” Practice Location

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