Provider Demographics
NPI:1518196179
Name:RIVARD, REBECCA A (DO)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:RIVARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:130 TOWN CENTER DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1744
Mailing Address - Country:US
Mailing Address - Phone:248-585-8265
Mailing Address - Fax:248-585-8266
Practice Address - Street 1:30695 LITTLE MACK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-1771
Practice Address - Country:US
Practice Address - Phone:586-294-9600
Practice Address - Fax:586-894-7570
Is Sole Proprietor?:No
Enumeration Date:2009-07-03
Last Update Date:2016-04-20
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Provider Licenses
StateLicense IDTaxonomies
PAOT013283208800000X
MI5101019550207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208800000XAllopathic & Osteopathic PhysiciansUrology