Healthcare Provider Details

I. General information

NPI: 1679949747
Provider Name (Legal Business Name): CHERJUAN HOVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24527 W CHICAGO
REDFORD MI
48239-1651
US

IV. Provider business mailing address

24527 W CHICAGO
REDFORD MI
48239-1651
US

V. Phone/Fax

Practice location:
  • Phone: 313-399-8254
  • Fax:
Mailing address:
  • Phone: 313-399-8254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number7112361
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: