MEDICARE: COURTNEY CAUDILL-SINGLETON MS

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	171M00000X	Case Manager/Care Coordinator		MI

General Provider Information

NPI Number	:	1225604218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY CAUDILL-SINGLETON MS

Provider Business Mailing Address
First Line	:	13101 ALLEN RD
Second Line	:
City	:	SOUTHGATE
State	:	MI
Zip	:	48195-2216
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	48031 S I 94 SERVCE DR APT 309
Second Line	:
City	:	VAN BUREN TWP
State	:	MI
Zip	:	48111-1736
Country	:	US
Telephone Number	:	616-594-4086
Fax Number	:

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

Provider Enumeration Date	:	06/01/2021
Last Update Date	:	06/08/2021

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