Individual
RTAYVUS WEST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
16500 QUARRY RD, SOUTHGATE, MI 48195-1426
(313) 551-1612
Mailing address
16500 QUARRY, SOUTHGATE, MI 48195-1451
(313) 551-1612
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
MI
101Y00000X
Counselor
—
—
Other
Enumeration date
09/24/2024
Last updated
09/24/2024
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