Healthcare Provider Details

I. General information

NPI: 1619547205
Provider Name (Legal Business Name): LACE CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18440 MIDWAY AVE
SOUTHFIELD MI
48075-7139
US

IV. Provider business mailing address

18440 MIDWAY AVE
SOUTHFIELD MI
48075-7139
US

V. Phone/Fax

Practice location:
  • Phone: 248-730-1740
  • Fax:
Mailing address:
  • Phone: 248-730-1740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MS. MAKIESHA GAFFORD
Title or Position: CERTIFIED PROFESSIONAL CODER
Credential: CPC
Phone: 313-600-0099