MEDICARE: TIPHANIE DUDLEY

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1477369460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIPHANIE DUDLEY

Provider Business Mailing Address
First Line	:	524 KITCHENER ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48215-3203
Country	:	US
Telephone Number	:	313-265-6420
Fax Number	:

Provider Business Practice Location Address
First Line	:	6957 N BEECH DALY RD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2089
Country	:	US
Telephone Number	:	313-556-6714
Fax Number	:

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

Provider Enumeration Date	:	12/05/2024
Last Update Date	:	12/05/2024

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Directions to “ TIPHANIE DUDLEY ” Practice Location

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