Organization
TRACEY TOROSIAN, PH.D., PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACEY TOROSIAN PH.D. (SOLE PROPRIETOR)
(586) 774-7344
Entity
Organization
Contact information
Practice address
20816 E 11 MILE RD, SUITE 112, SAINT CLAIR SHORES, MI 48081-1565
(586) 774-7344
(586) 774-7345
Mailing address
20816 E 11 MILE RD, SUITE 112, SAINT CLAIR SHORES, MI 48081-1565
(586) 774-7344
(586) 774-7345
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
6301009014
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1962531335
NPI TYPE 1
MI
01
—
680E046090
BLUE CROSS BLUE SHIELD OF MICHIGAN
MI
Enumeration date
01/13/2011
Last updated
01/13/2011
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