Individual
MRS. EVELYN RUTH SOMMARIVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
285 N. LILLEY RD, CANTON, MI 48187-4849
(734) 495-1506
(734) 495-1780
Mailing address
43151 DALCOMA DR, SUITE 1, CLINTON TOWNSHIP, MI 48038-6306
(586) 286-8720
(586) 286-8723
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601005023
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0F31794
BCBS OF MI
MI
Enumeration date
07/26/2007
Last updated
04/01/2009
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