MEDICARE: IMEN HAROON

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	225200000X	Physical Therapy Assistant	L1643299	MI

General Provider Information

NPI Number	:	1386973279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IMEN HAROON

Provider Business Mailing Address
First Line	:	3039 RIVER MEADOW CIR
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-2382
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3039 RIVER MEADOW CIR
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-2382
Country	:	US
Telephone Number	:	313-510-5227
Fax Number	:	734-495-0616

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

Provider Enumeration Date	:	12/23/2009
Last Update Date	:	12/23/2009

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Directions to “ IMEN HAROON ” Practice Location

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