Provider Demographics
NPI:1871759357
Name:CETNER, EMILY LYNN (DO)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:LYNN
Last Name:CETNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:LYNN
Other - Last Name:WOLFSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5793 W MAPLE RD STE 153
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4478
Mailing Address - Country:US
Mailing Address - Phone:248-539-7726
Mailing Address - Fax:248-539-7823
Practice Address - Street 1:5793 W MAPLE RD STE 153
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4478
Practice Address - Country:US
Practice Address - Phone:248-539-7726
Practice Address - Fax:248-539-7823
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036125387208000000X
MI5101020824208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics