MEDICARE: BIRDIE MAE'S BRUNCH BAR

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	343900000X	Non-emergency Medical Transport (VAN)
2	174200000X	Meals Provider

General Provider Information

NPI Number	:	1689512899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIRDIE MAE'S BRUNCH BAR

Provider Business Mailing Address
First Line	:	6381 W OUTER DR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-2719
Country	:	US
Telephone Number	:	248-605-1516
Fax Number	:

Provider Business Practice Location Address
First Line	:	6381 W OUTER DR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-2719
Country	:	US
Telephone Number	:	248-605-1516
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CIERRA MCFARLIN
Credential	:
Telephone Number	:	248-605-1516

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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