MEDICARE: JIMIA STARR GREEN PHLEBOTOMY

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	3747A0650X	Attendant Care Provider		MI

General Provider Information

NPI Number	:	1578426839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMIA STARR GREEN PHLEBOTOMY

Provider Business Mailing Address
First Line	:	19301 ARDMORE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-1704
Country	:	US
Telephone Number	:	313-370-7849
Fax Number	:	231-216-7861

Provider Business Practice Location Address
First Line	:	16129 W MCNICHOLS ROAD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-1704
Country	:	US
Telephone Number	:	313-370-7849
Fax Number	:	231-216-7861

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

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	03/12/2026

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Directions to “ JIMIA STARR GREEN PHLEBOTOMY” Practice Location

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