MEDICARE: TERRANCE LAMARQUE

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	376K00000X	Nurse's Aide	MI000007629	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	824066361	OTHER		HOME CARE

General Provider Information

NPI Number	:	1225536634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRANCE LAMARQUE

Provider Business Mailing Address
First Line	:	20046 WASHBURN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221-1020
Country	:	US
Telephone Number	:	313-258-6847
Fax Number	:

Provider Business Practice Location Address
First Line	:	20046 WASHBURN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221-1020
Country	:	US
Telephone Number	:	313-258-6847
Fax Number	:

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

Provider Enumeration Date	:	01/31/2018
Last Update Date	:	01/31/2018

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Directions to “ TERRANCE LAMARQUE ” Practice Location

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