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NPI Code Detail

MEDICARE: MYRIAH GRAHAM

MEDICARE: MYRIAH GRAHAM
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1104555275
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYRIAH GRAHAM
Provider Business Mailing Address
First Line : 3111 GRAND RIVER AVE
Second Line :
City : DETROIT
State : MI
Zip : 48208-2962
Country : US
Telephone Number : 313-557-8719
Fax Number : 313-456-9601
Provider Business Practice Location Address
First Line : 3111 GRAND RIVER AVE
Second Line :
City : DETROIT
State : MI
Zip : 48208-2962
Country : US
Telephone Number : 313-557-8719
Fax Number : 313-456-9601
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2022
Last Update Date : 06/06/2022

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