Individual
MS. ALESSANDRA MACEDO DE MOURA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
23077 GREENFIELD RD STE 110, SOUTHFIELD, MI 48075-3744
(248) 569-3002
(248) 569-3008
Mailing address
23077 GREENFIELD RD STE 110, SOUTHFIELD, MI 48075-3744
(248) 569-3002
(248) 569-3008
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501013812
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
650F30621
BLUE CROSS/BLUE SHIELD OF MICHIGAN
MI
Enumeration date
05/05/2008
Last updated
12/12/2008
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