MEDICARE: ASHLEY WHITEHEAD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver

General Provider Information

NPI Number	:	1043935059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY WHITEHEAD

Provider Business Mailing Address
First Line	:	3716 SPRING HILL AVE
Second Line	:
City	:	INKSTER
State	:	MI
Zip	:	48141-2138
Country	:	US
Telephone Number	:	313-258-4097
Fax Number	:

Provider Business Practice Location Address
First Line	:	3716 SPRING HILL AVE
Second Line	:
City	:	INKSTER
State	:	MI
Zip	:	48141-2138
Country	:	US
Telephone Number	:	313-258-4097
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2022
Last Update Date	:	10/11/2022

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Directions to “ ASHLEY WHITEHEAD ” Practice Location

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