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NPI Code Detail

MEDICARE: NIRA MCCOLLUM LMT

MEDICARE:   NIRA  MCCOLLUM  LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist7501015309MI

General Provider Information

NPI Number : 1093549792
Entity Type Code : Individual
Provider Name (Legal Business Name) : NIRA MCCOLLUM LMT
Provider Business Mailing Address
First Line : 22450 SHEVINGTON DR
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48034-2129
Country : US
Telephone Number : 248-915-8684
Fax Number :
Provider Business Practice Location Address
First Line : 1961 S TELEGRAPH RD
Second Line :
City : BLOOMFIELD HILLS
State : MI
Zip : 48302-0246
Country : US
Telephone Number : 833-246-4347
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2024
Last Update Date : 08/27/2024

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Directions to “ NIRA MCCOLLUM LMT” Practice Location

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