Provider Demographics
NPI:1215236369
Name:KERI TOPOUZIAN, DO PC
Entity type:Organization
Organization Name:KERI TOPOUZIAN, DO PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KERI
Authorized Official - Middle Name:
Authorized Official - Last Name:TOPOUZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:616-285-3707
Mailing Address - Street 1:1900 S TELEGRAPH RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0238
Mailing Address - Country:US
Mailing Address - Phone:248-302-0473
Mailing Address - Fax:
Practice Address - Street 1:1000 E PARIS AVE SE
Practice Address - Street 2:SUITE 138
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3691
Practice Address - Country:US
Practice Address - Phone:616-285-3707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008226291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory