MEDICARE: LINDA UKOMADU

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	163W00000X	Registered Nurse	4704296401	MI

General Provider Information

NPI Number	:	1639676026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA UKOMADU

Provider Business Mailing Address
First Line	:	7480 SAINT AUBURN DR
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-3713
Country	:	US
Telephone Number	:	313-510-6386
Fax Number	:

Provider Business Practice Location Address
First Line	:	7480 SAINT AUBURN DR
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-3713
Country	:	US
Telephone Number	:	313-510-6386
Fax Number	:

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

Provider Enumeration Date	:	04/11/2018
Last Update Date	:	04/11/2018

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Directions to “ LINDA UKOMADU ” Practice Location

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