Healthcare Provider Details

I. General information

NPI: 1194611012
Provider Name (Legal Business Name): LEXUS HOLDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29200 NORTHWESTERN HWY STE 110
SOUTHFIELD MI
48034-1055
US

IV. Provider business mailing address

23140 PARKLAWN ST
OAK PARK MI
48237-3639
US

V. Phone/Fax

Practice location:
  • Phone: 248-483-7804
  • Fax:
Mailing address:
  • Phone: 313-676-7998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: