MEDICARE: MS. ROSLEE ELLEN UREY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	126900000X	Dental Laboratory Technician
2	132700000X	Dietary Manager
3	146L00000X	Paramedic	MI
4	293D00000X	Physiological Laboratory
5	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194217448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROSLEE ELLEN UREY

Provider Business Mailing Address
First Line	:	22394 BUCKINGHAM DR
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48335-5429
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22394 BUCKINGHAM DR
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48335-5429
Country	:	US
Telephone Number	:	248-516-4335
Fax Number	:

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

Provider Enumeration Date	:	06/02/2018
Last Update Date	:	06/02/2018

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