Individual
DR. AMY PHILOMENA DEROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
33200 W 14 MILE RD STE 180, WEST BLOOMFIELD, MI 48322-3587
(248) 688-7597
(248) 498-6060
Mailing address
33200 W 14 MILE RD STE 180, WEST BLOOMFIELD, MI 48322-3587
(248) 688-7597
(248) 498-6060
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
5101017043
MI
208600000X
Surgery Physician
5101017043
MI
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
5101017043
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1598971327
—
MI
Enumeration date
05/16/2007
Last updated
10/05/2021
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