MEDICARE: KEARA J MARKS

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	363LF0000X	Family Nurse Practitioner	4704309972	MI

General Provider Information

NPI Number	:	1720757628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEARA J MARKS

Provider Business Mailing Address
First Line	:	1 FORD PL STE 3A
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-3450
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2425 TUXEDO ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48206-1222
Country	:	US
Telephone Number	:	313-484-5830
Fax Number	:

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

Provider Enumeration Date	:	09/13/2021
Last Update Date	:	09/06/2023

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Directions to “ KEARA J MARKS ” Practice Location

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