Healthcare Provider Details

I. General information

NPI: 1700321973
Provider Name (Legal Business Name): MS. TAMIKO WATKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. TAMIKO WATKINS

II. Dates (important events)

Enumeration Date: 12/27/2016
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24600 NORTHWESTERN HWY
SOUTHFIELD MI
48075-2471
US

IV. Provider business mailing address

23110 ORLEANS PL UNIT 4211
SOUTHFIELD MI
48033-3303
US

V. Phone/Fax

Practice location:
  • Phone: 800-615-0411
  • Fax:
Mailing address:
  • Phone: 800-615-0411
  • 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: