MEDICARE: TEQUILA HARRIS

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1649139296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEQUILA HARRIS

Provider Business Mailing Address
First Line	:	26688 ANDOVER ST
Second Line	:
City	:	INKSTER
State	:	MI
Zip	:	48141-3143
Country	:	US
Telephone Number	:	313-518-2933
Fax Number	:

Provider Business Practice Location Address
First Line	:	26688 ANDOVER ST
Second Line	:
City	:	INKSTER
State	:	MI
Zip	:	48141-3143
Country	:	US
Telephone Number	:	313-518-2933
Fax Number	:

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

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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Directions to “ TEQUILA HARRIS ” Practice Location

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