MEDICARE: MS. FELICIA SUE CALLEBS

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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1508651191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. FELICIA SUE CALLEBS

Provider Business Mailing Address
First Line	:	1470 E WOODWARD HEIGHTS BLVD APT C5
Second Line	:
City	:	HAZEL PARK
State	:	MI
Zip	:	48030-1644
Country	:	US
Telephone Number	:	248-519-3017
Fax Number	:

Provider Business Practice Location Address
First Line	:	1480 E WOODWARD HEIGHTS BLVD APT B4
Second Line	:
City	:	HAZEL PARK
State	:	MI
Zip	:	48030-1637
Country	:	US
Telephone Number	:	947-277-0575
Fax Number	:

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

Provider Enumeration Date	:	04/14/2025
Last Update Date	:	04/14/2025

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