MEDICARE: JOANN CARMESHA MOSS

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	305R00000X	Preferred Provider Organization

General Provider Information

NPI Number	:	1376221689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANN CARMESHA MOSS

Provider Business Mailing Address
First Line	:	8203 ROBSON ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48228-2457
Country	:	US
Telephone Number	:	313-690-9324
Fax Number	:

Provider Business Practice Location Address
First Line	:	9313 MONTROSE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48228-2126
Country	:	US
Telephone Number	:	313-293-0423
Fax Number	:

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

Provider Enumeration Date	:	07/06/2023
Last Update Date	:	07/06/2023

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Directions to “ JOANN CARMESHA MOSS ” Practice Location

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