Healthcare Provider Details

I. General information

NPI: 1083555312
Provider Name (Legal Business Name): TALISHA MICHELE UNDERWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29649 RED CEDAR DR
FLAT ROCK MI
48134-1317
US

IV. Provider business mailing address

29649 RED CEDAR DR
FLAT ROCK MI
48134-1317
US

V. Phone/Fax

Practice location:
  • Phone: 734-309-9344
  • Fax:
Mailing address:
  • Phone: 734-309-9344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberMI000043210
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: