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NPI Code Detail

MEDICARE: RICO FLUELLEN

MEDICARE: RICO FLUELLEN
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
11041C0700XClinical Social Worker
2261QM0850XAdult Mental Health Clinic/Center

General Provider Information

NPI Number : 1457841868
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICO FLUELLEN
Provider Business Mailing Address
First Line : 290 TOWN CENTER DR STE 400
Second Line :
City : DEARBORN
State : MI
Zip : 48126-2765
Country : US
Telephone Number : 888-813-8326
Fax Number :
Provider Business Practice Location Address
First Line : 5200 STECKER ST
Second Line :
City : DEARBORN
State : MI
Zip : 48126-3813
Country : US
Telephone Number : 888-813-8326
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2018
Last Update Date : 11/20/2024

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Directions to “ RICO FLUELLEN ” Practice Location

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