MEDICARE: MS. ANGELA MARIA TREPANIER M.S.

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	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1619044310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA MARIA TREPANIER M.S.

Provider Business Mailing Address
First Line	:	540 E CANFIELD ST
Second Line	:	2375 SCOTT HALL
City	:	DETROIT
State	:	MI
Zip	:	48201-1928
Country	:	US
Telephone Number	:	313-577-3425
Fax Number	:	313-577-9137

Provider Business Practice Location Address
First Line	:	540 E CANFIELD ST
Second Line	:	2375 SCOTT HALL
City	:	DETROIT
State	:	MI
Zip	:	48201-1928
Country	:	US
Telephone Number	:	313-577-3425
Fax Number	:	313-577-9137

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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