MEDICARE: MAXINE AMEEN

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	376G00000X	Nursing Home Administrator

General Provider Information

NPI Number	:	1346836905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAXINE AMEEN

Provider Business Mailing Address
First Line	:	5309 MCCLELLAN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48213-3045
Country	:	US
Telephone Number	:	586-554-0392
Fax Number	:

Provider Business Practice Location Address
First Line	:	5309 MCCLELLAN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48213-3045
Country	:	US
Telephone Number	:	586-554-0392
Fax Number	:

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

Provider Enumeration Date	:	12/17/2020
Last Update Date	:	12/17/2020

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Directions to “ MAXINE AMEEN ” Practice Location

Language	Start Address	Practice Location

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