MEDICARE: KIESHA CALDWELL

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	2278H0200X	Home Health Certified Respiratory Therapist

General Provider Information

NPI Number	:	1609485903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIESHA CALDWELL

Provider Business Mailing Address
First Line	:	PO BOX 4593
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48204-0593
Country	:	US
Telephone Number	:	623-888-9229
Fax Number	:

Provider Business Practice Location Address
First Line	:	16595 ASHTON AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48219-4104
Country	:	US
Telephone Number	:	623-888-9229
Fax Number	:

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

Provider Enumeration Date	:	07/23/2020
Last Update Date	:	07/23/2020

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Directions to “ KIESHA CALDWELL ” Practice Location

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