Basic Information
| Provider Information | |||||||||
| NPI: | 1134463201 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SESKI | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | THERESE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.D., C.S.R. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CLOR | ||||||||
| OtherFirstName: | MARY | ||||||||
| OtherMiddleName: | THERESE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | R.D., C.S.R. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 45640 SCHOENHERR RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | SHELBY TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483156033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5862474300 | ||||||||
| FaxNumber: | 5865326496 | ||||||||
| Practice Location | |||||||||
| Address1: | 22201 MOROSS RD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482362169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138868787 | ||||||||
| FaxNumber: | 3138864103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2012 | ||||||||
| LastUpdateDate: | 11/15/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 65580 | MI | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.