Healthcare Provider Details

I. General information

NPI: 1053868935
Provider Name (Legal Business Name): KEIARA BELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 E HANCOCK ST APARTMENT 812
DETROIT MI
48201-1311
US

IV. Provider business mailing address

80 E HANCOCK ST APARTMENT 812
DETROIT MI
48201-1311
US

V. Phone/Fax

Practice location:
  • Phone: 313-377-5648
  • Fax:
Mailing address:
  • Phone: 313-377-5648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberB400465085608
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: