MEDICARE: PAM PARKER

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	104100000X	Social Worker	6802085338	MI

General Provider Information

NPI Number	:	1528160017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAM PARKER

Provider Business Mailing Address
First Line	:	18829 DEAN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-2025
Country	:	US
Telephone Number	:	313-893-2648
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 E 12 MILE RD
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-2651
Country	:	US
Telephone Number	:	248-547-2223
Fax Number	:

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

Provider Enumeration Date	:	09/04/2006
Last Update Date	:	07/08/2007

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Directions to “ PAM PARKER ” Practice Location

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