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NPI Code Detail

MEDICARE: HUBERT MAYBERRY

MEDICARE:   HUBERT  MAYBERRY
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
1171M00000XCase Manager/Care Coordinator
2172A00000XDriver

General Provider Information

NPI Number : 1720472681
Entity Type Code : Individual
Provider Name (Legal Business Name) : HUBERT MAYBERRY
Provider Business Mailing Address
First Line : 19436 PACKARD ST
Second Line :
City : DETROIT
State : MI
Zip : 48234-3195
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 19436 PACKARD ST
Second Line :
City : DETROIT
State : MI
Zip : 48234-3195
Country : US
Telephone Number : 313-231-6049
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2015
Last Update Date : 03/27/2015

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Directions to “ HUBERT MAYBERRY ” Practice Location

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