MEDICARE: SOYINA MALIK BAZEMORE

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	251G00000X	Community Based Hospice Care Agency
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1558217885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOYINA MALIK BAZEMORE

Provider Business Mailing Address
First Line	:	11000 W MCNICHOLS RD STE 323-1056
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221-2357
Country	:	US
Telephone Number	:	586-569-9147
Fax Number	:

Provider Business Practice Location Address
First Line	:	11000 W MCNICHOLS RD STE 323-1056
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221-2357
Country	:	US
Telephone Number	:	586-569-9147
Fax Number	:

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

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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