MEDICARE: CHARMAINE LAND

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	:	1518417716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARMAINE LAND

Provider Business Mailing Address
First Line	:	26759 SUNNINGDALE DR
Second Line	:
City	:	INKSTER
State	:	MI
Zip	:	48141-1809
Country	:	US
Telephone Number	:	313-879-9419
Fax Number	:

Provider Business Practice Location Address
First Line	:	26759 SUNNINGDALE DR
Second Line	:
City	:	INKSTER
State	:	MI
Zip	:	48141-1809
Country	:	US
Telephone Number	:	313-879-9419
Fax Number	:

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

Provider Enumeration Date	:	10/11/2016
Last Update Date	:	03/22/2026

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Directions to “ CHARMAINE LAND ” Practice Location

Language	Start Address	Practice Location

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