Provider Demographics
NPI:1801081625
Name:ADVANCED REPRODUCTIVE MEDICINE & SURGERY, PC
Entity type:Organization
Organization Name:ADVANCED REPRODUCTIVE MEDICINE & SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:HELKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-203-0900
Mailing Address - Street 1:4190 TELEGRAPH ROAD
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302
Mailing Address - Country:US
Mailing Address - Phone:248-203-0900
Mailing Address - Fax:
Practice Address - Street 1:4190 TELEGRAPH RD
Practice Address - Street 2:SUITE 1500
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-2079
Practice Address - Country:US
Practice Address - Phone:248-203-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDB038087207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1606358661OtherBCBS
MI1606358691OtherBCBS
MI1606358691OtherBCBS
MIB47378Medicare UPIN