MEDICARE: MRS. JAMIE M-E WEDGE PARA TATTOOIST MEDIC

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	174400000X	Specialist	BA-01066	MI
2	246ZA2600X	Medical Art Specialist/Technologist	BA-01066	MI

General Provider Information

NPI Number	:	1558132126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAMIE M-E WEDGE PARA TATTOOIST MEDIC

Provider Business Mailing Address
First Line	:	9541 MAIN ST
Second Line	:
City	:	WHITMORE LAKE
State	:	MI
Zip	:	48189-9658
Country	:	US
Telephone Number	:	734-333-5067
Fax Number	:

Provider Business Practice Location Address
First Line	:	9541 MAIN ST
Second Line	:
City	:	WHITMORE LAKE
State	:	MI
Zip	:	48189
Country	:	US
Telephone Number	:	734-333-5067
Fax Number	:

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

Provider Enumeration Date	:	01/12/2024
Last Update Date	:	09/10/2025

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