Healthcare Provider Details

I. General information

NPI: 1083996102
Provider Name (Legal Business Name): WINCHESTER SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18470 SANTA ANN AVE.
LATHRUP VILLAGE MI
48076-4525
US

IV. Provider business mailing address

18470 SANTA ANN AVE
LATHRUP VILLAGE MI
48076-4525
US

V. Phone/Fax

Practice location:
  • Phone: 313-477-3055
  • Fax:
Mailing address:
  • Phone: 313-477-3055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: IRIS LENA WINCHESTER
Title or Position: OWNER
Credential:
Phone: 313-477-3055