MEDICARE: PORSHA DYE

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
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1104701614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PORSHA DYE

Provider Business Mailing Address
First Line	:	6111 MARSEILLES ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48224-1325
Country	:	US
Telephone Number	:	313-544-0696
Fax Number	:

Provider Business Practice Location Address
First Line	:	2326 E 7 MILE RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-1304
Country	:	US
Telephone Number	:	313-544-0696
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2025
Last Update Date	:	08/28/2025

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