Renovis Health LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

RENOVIS HEALTH LLC

Doing business as

Renovis Health

Practice address

26206 W 12 Mile Rd Ste 302
Southfield, MI 48034-8501

Phone

(424) 303-0544

NPI assigned

Sep 30, 2020

Last updated

Mar 13, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Olisaeloka Dallah

Title

Chief Administrative Officer

Phone

(248) 470-7318

Specialties & licenses 4

Addresses

Other names 1

• Renovis Health Doing business as

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678665600000",
    "number": "1205443504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29155 NORTHWESTERN HWY # 515",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480341011",
            "telephone_number": "800-960-1463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26206 W 12 MILE RD STE 302",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480348501",
            "telephone_number": "424-303-0544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENOVIS HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-30",
        "last_updated": "2023-03-13",
        "certification_date": "2023-03-13",
        "status": "A",
        "authorized_official_last_name": "DALLAH",
        "authorized_official_first_name": "OLISAELOKA",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "248-470-7318"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Doctor@Hvmd.net",
            "affiliation": "N",
            "endpointDescription": "Doctor@Hvmd.net",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "26206 W 12 Mile Rd Ste 302",
            "city": "Southfield",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480348501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Renovis Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Renovis Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Internal Medicine Physician in Southfield, MI
• Providers in Southfield, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.