Basic Information
| Provider Information | |||||||||
| NPI: | 1720089550 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSSI | ||||||||
| FirstName: | RENATA | ||||||||
| MiddleName: | BARBARA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SOBECKA | ||||||||
| OtherFirstName: | RENATA | ||||||||
| OtherMiddleName: | BARBARA | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | NP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 16001 W 9 MILE RD | ||||||||
| Address2: | DEPT OF SURGERY | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480754818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488493000 | ||||||||
| FaxNumber: | 2484653146 | ||||||||
| Practice Location | |||||||||
| Address1: | 16001 WEST NINE MILE RD | ||||||||
| Address2: | DEPT OF CARDIOVASCULAR SURGERY | ||||||||
| City: | SOTUFHIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488493000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 03/30/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 4704173902 | MI | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 391 | 01 | MI | MI COUNCIL OF NP'S | OTHER | 0204457 | 01 | HONOR SOCIETY OF NURSING | OTHER | MR1091014 | 01 | FEDERAL DEA | OTHER |