MEDICARE: MRS. VIKKI ANNE BROCK

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	171M00000X	Case Manager/Care Coordinator	727873	MI

General Provider Information

NPI Number	:	1770807596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VIKKI ANNE BROCK

Provider Business Mailing Address
First Line	:	15401 VIVIAN ST
Second Line	:
City	:	TAYLOR
State	:	MI
Zip	:	48180-5021
Country	:	US
Telephone Number	:	248-613-7019
Fax Number	:

Provider Business Practice Location Address
First Line	:	15401 VIVIAN ST
Second Line	:
City	:	TAYLOR
State	:	MI
Zip	:	48180-5021
Country	:	US
Telephone Number	:	248-613-7019
Fax Number	:

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

Provider Enumeration Date	:	03/23/2010
Last Update Date	:	04/12/2026

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