MEDICARE: DENISE S MUHAMMAD RN

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	163WC1500X	Community Health Registered Nurse	4704381646	MI

General Provider Information

NPI Number	:	1619734928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE S MUHAMMAD RN

Provider Business Mailing Address
First Line	:	15502 BEAVERLAND ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48223-1473
Country	:	US
Telephone Number	:	248-242-3286
Fax Number	:

Provider Business Practice Location Address
First Line	:	15502 BEAVERLAND ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48223-1473
Country	:	US
Telephone Number	:	248-242-3286
Fax Number	:

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

Provider Enumeration Date	:	03/04/2024
Last Update Date	:	03/04/2024

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