MEDICARE: ROXOLANA KARANECRH 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
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1801901392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROXOLANA KARANECRH RD

Provider Business Mailing Address
First Line	:	22300 BON BRAE ST
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48081-2236
Country	:	US
Telephone Number	:	586-779-7901
Fax Number	:	586-779-7114

Provider Business Practice Location Address
First Line	:	22300 BON BRAE ST
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48081-2236
Country	:	US
Telephone Number	:	586-779-7901
Fax Number	:	586-779-7114

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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