Individual
RITA CORAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
22060 BEECH ST STE 200, DEARBORN, MI 48124-2853
(313) 228-0505
(313) 228-0506
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
(947) 522-1863
(947) 522-0307
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
4301116063
MI
207RC0000X
Cardiovascular Disease Physician
TP446
KY
207RI0011X
Interventional Cardiology Physician
41345
KY
207RI0011X
Interventional Cardiology Physician
4301116063
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100009490
—
KY
Enumeration date
08/01/2007
Last updated
07/14/2022
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