MEDICARE: LAKESHA ANDERSON

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	247200000X	Other Technician

General Provider Information

NPI Number	:	1053775924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKESHA ANDERSON

Provider Business Mailing Address
First Line	:	15230 NORTHGATE BLVD APT 201
Second Line	:
City	:	OAK PARK
State	:	MI
Zip	:	48237-3310
Country	:	US
Telephone Number	:	313-717-3497
Fax Number	:

Provider Business Practice Location Address
First Line	:	3627 W VERNOR HWY
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48216-1440
Country	:	US
Telephone Number	:	313-297-2975
Fax Number	:

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

Provider Enumeration Date	:	04/07/2016
Last Update Date	:	04/07/2016

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Directions to “ LAKESHA ANDERSON ” Practice Location

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