Individual
GWENDOLYN D BUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
23195 RIVERSIDE DR, SOUTHFIELD, MI 48033-7301
(954) 806-9411
Mailing address
23195 RIVERSIDE DR, SOUTHFIELD, MI 48033-7301
(954) 806-9411
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9521503
—
MI
Enumeration date
04/20/2021
Last updated
04/20/2021
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