MEDICARE: RENEE L OLIVER

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	156F00000X	Technician/Technologist

General Provider Information

NPI Number	:	1477257244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE L OLIVER

Provider Business Mailing Address
First Line	:	50194 SCHOENHERR RD
Second Line	:
City	:	SHELBY TWP
State	:	MI
Zip	:	48315-3136
Country	:	US
Telephone Number	:	586-991-6596
Fax Number	:	248-712-4381

Provider Business Practice Location Address
First Line	:	50194 SCHOENHERR RD
Second Line	:
City	:	SHELBY TWP
State	:	MI
Zip	:	48315-3136
Country	:	US
Telephone Number	:	586-991-6596
Fax Number	:	248-712-4381

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

Provider Enumeration Date	:	03/28/2023
Last Update Date	:	03/28/2023

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