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NPI Code Detail

MEDICARE: AMY GROESBECK

MEDICARE: AMY GROESBECK
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
1103TC0700XClinical Psychologist6301014507MI

General Provider Information

NPI Number : 1770897613
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY GROESBECK
Provider Business Mailing Address
First Line : 10909 HANNAN RD
Second Line :
City : ROMULUS
State : MI
Zip : 48174-1383
Country : US
Telephone Number : 734-893-1000
Fax Number :
Provider Business Practice Location Address
First Line : 10909 HANNAN RD
Second Line :
City : ROMULUS
State : MI
Zip : 48174-1383
Country : US
Telephone Number : 734-893-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2010
Last Update Date : 11/16/2016

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