MEDICARE: ANNE MARIE YURIK PH.D.

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	103T00000X	Psychologist	6301007587	MI

General Provider Information

NPI Number	:	1861430993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE MARIE YURIK PH.D.

Provider Business Mailing Address
First Line	:	501 LOCKMOORE CT
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-4228
Country	:	US
Telephone Number	:	248-299-4267
Fax Number	:	248-413-4059

Provider Business Practice Location Address
First Line	:	200 DIVERSION ST
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-2245
Country	:	US
Telephone Number	:	248-299-4315
Fax Number	:	248-413-4059

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	07/08/2007

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