1720089550 NPI number — RENATA BARBARA ROSSI NP

Table of content: RENATA BARBARA ROSSI NP (NPI 1720089550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720089550 NPI number — RENATA BARBARA ROSSI NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSSI
Provider First Name:
RENATA
Provider Middle Name:
BARBARA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SOBECKA
Provider Other First Name:
RENATA
Provider Other Middle Name:
BARBARA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720089550
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16001 W 9 MILE RD
Provider Second Line Business Mailing Address:
DEPT OF SURGERY
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48075-4818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-849-3000
Provider Business Mailing Address Fax Number:
248-465-3146

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16001 WEST NINE MILE RD
Provider Second Line Business Practice Location Address:
DEPT OF CARDIOVASCULAR SURGERY
Provider Business Practice Location Address City Name:
SOTUFHIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-849-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/02/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  4704173902 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 391 . This is a "MI COUNCIL OF NP'S" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0204457 . This is a "HONOR SOCIETY OF NURSING" identifier . This identifiers is of the category "OTHER".