Healthcare Provider Details

I. General information

NPI: 1447803457
Provider Name (Legal Business Name): ALISA KEYNA TURNER CPRM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 E MCNICHOLS RD
DETROIT MI
48203-2857
US

IV. Provider business mailing address

24556 LITTLE MACK AVE
SAINT CLAIR SHORES MI
48080-3204
US

V. Phone/Fax

Practice location:
  • Phone: 313-365-3100
  • Fax:
Mailing address:
  • Phone: 248-284-5507
  • Fax: 248-544-2445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: