Provider Demographics
NPI:1972689453
Name:REPRODUCTIVE MEDICINE ASSOC.
Entity Type:Organization
Organization Name:REPRODUCTIVE MEDICINE ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WROLSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-619-3100
Mailing Address - Street 1:130 TOWN CENTER DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1744
Mailing Address - Country:US
Mailing Address - Phone:248-619-9030
Mailing Address - Fax:248-619-9031
Practice Address - Street 1:130 TOWN CENTER DR
Practice Address - Street 2:SUITE 106
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-1744
Practice Address - Country:US
Practice Address - Phone:248-619-9030
Practice Address - Fax:248-619-9031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty