Basic Information
| Provider Information | |||||||||
| NPI: | 1518196179 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIVARD | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 TOWN CENTER DR | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480841744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485858265 | ||||||||
| FaxNumber: | 2485858266 | ||||||||
| Practice Location | |||||||||
| Address1: | 30695 LITTLE MACK AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ROSEVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480661771 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5862949600 | ||||||||
| FaxNumber: | 5868947570 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2009 | ||||||||
| LastUpdateDate: | 04/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | OT013283 | PA | N | Allopathic & Osteopathic Physicians | Urology | 207Q00000X | 5101019550 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.