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NPI Code Detail

MEDICARE: TINA MOORE

MEDICARE: TINA MOORE
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
1156F00000XTechnician/Technologist

General Provider Information

NPI Number : 1285018614
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA MOORE
Provider Business Mailing Address
First Line : 33464 SCHOENHERR RD STE 180
Second Line :
City : STERLING HEIGHTS
State : MI
Zip : 48312-6392
Country : US
Telephone Number : 702-354-3753
Fax Number :
Provider Business Practice Location Address
First Line : 33464 SCHOENHERR RD STE 180
Second Line :
City : STERLING HEIGHTS
State : MI
Zip : 48312-6392
Country : US
Telephone Number : 702-354-3753
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2015
Last Update Date : 04/25/2022

Similar Medicare Providers

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Directions to “ TINA MOORE ” Practice Location

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