MEDICARE: MS. INGER BLAIR

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	:	1215729587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. INGER BLAIR

Provider Business Mailing Address
First Line	:	2360 ORCHARD LAKE RD STE 105
Second Line	:
City	:	SYLVAN LAKE
State	:	MI
Zip	:	48320-1613
Country	:	US
Telephone Number	:	248-682-0088
Fax Number	:	248-682-6044

Provider Business Practice Location Address
First Line	:	2360 ORCHARD LAKE RD STE 1052360
Second Line	:
City	:	SYLVAN LAKE
State	:	MI
Zip	:	48320-1613
Country	:	US
Telephone Number	:	248-682-0088
Fax Number	:	248-682-6044

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

Provider Enumeration Date	:	05/21/2025
Last Update Date	:	05/21/2025

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