Provider Demographics
NPI:1548347370
Name:RAPP, JUDITH GITA (MD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:GITA
Last Name:RAPP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4000 HIGHLAND RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328
Mailing Address - Country:US
Mailing Address - Phone:248-738-9166
Mailing Address - Fax:248-738-9188
Practice Address - Street 1:4000 HIGHLAND RD STE 130
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-2168
Practice Address - Country:US
Practice Address - Phone:248-383-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044221207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301044221OtherPHYSICIAN LICENSE