MEDICARE: HEARTFELT PHYSICIAN SERVICES, PLLC

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	208D00000X	General Practice Physician
2	208D00000X	General Practice Physician	4301407599	MI

General Provider Information

NPI Number	:	1578505129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTFELT PHYSICIAN SERVICES, PLLC

Provider Business Mailing Address
First Line	:	20245 W 12 MILE RD
Second Line	:	STE 120
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-5409
Country	:	US
Telephone Number	:	248-552-1327
Fax Number	:	586-859-5729

Provider Business Practice Location Address
First Line	:	20245 W 12 MILE RD
Second Line	:	STE 120
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-5409
Country	:	US
Telephone Number	:	248-552-1327
Fax Number	:	586-859-5729

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. REBECCA KATHLEENE MOTLEY
Credential	:	MD
Telephone Number	:	248-552-1327

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	12/18/2020

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