MEDICARE: DOMINIQUE HOUSTON

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1538909031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIQUE HOUSTON

Provider Business Mailing Address
First Line	:	PO BOX 2881
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48333-2881
Country	:	US
Telephone Number	:
Fax Number	:	810-400-5954

Provider Business Practice Location Address
First Line	:	PO BOX 2881
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48333-2881
Country	:	US
Telephone Number	:	313-898-1703
Fax Number	:	810-400-5954

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

Provider Enumeration Date	:	05/31/2024
Last Update Date	:	05/31/2024

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Directions to “ DOMINIQUE HOUSTON ” Practice Location

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