MEDICARE: KEIARA BELL

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	B400465085608	MI

General Provider Information

NPI Number	:	1053868935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEIARA BELL

Provider Business Mailing Address
First Line	:	80 E HANCOCK ST
Second Line	:	APARTMENT 812
City	:	DETROIT
State	:	MI
Zip	:	48201-1311
Country	:	US
Telephone Number	:	313-377-5648
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 E HANCOCK ST
Second Line	:	APARTMENT 812
City	:	DETROIT
State	:	MI
Zip	:	48201-1311
Country	:	US
Telephone Number	:	313-377-5648
Fax Number	:

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

Provider Enumeration Date	:	09/08/2016
Last Update Date	:	09/08/2016

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Directions to “ KEIARA BELL ” Practice Location

Language	Start Address	Practice Location

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