Healthcare Provider Details

I. General information

NPI: 1407489289
Provider Name (Legal Business Name): TOTAL HEALTH CARE MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14650 W WARREN AVE STE 300
DEARBORN MI
48126-1782
US

IV. Provider business mailing address

17260 W 10 MILE RD
SOUTHFIELD MI
48075-2949
US

V. Phone/Fax

Practice location:
  • Phone: 313-551-3941
  • Fax: 313-633-9619
Mailing address:
  • Phone: 248-809-6553
  • Fax: 248-809-6583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. BIANCA D LEVERETT
Title or Position: OWNER
Credential:
Phone: 248-809-6553