MEDICARE: MICHAEL K TOWERS MA, LLP

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	103TC0700X	Clinical Psychologist	6301011505	MI

General Provider Information

NPI Number	:	1780863159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL K TOWERS MA, LLP

Provider Business Mailing Address
First Line	:	18810 SAN QUENTIN DR
Second Line	:
City	:	LATHRUP VILLAGE
State	:	MI
Zip	:	48076-7811
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18810 SAN QUENTIN DR
Second Line	:
City	:	LATHRUP VILLAGE
State	:	MI
Zip	:	48076-7811
Country	:	US
Telephone Number	:	248-910-8533
Fax Number	:

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

Provider Enumeration Date	:	11/01/2007
Last Update Date	:	11/01/2007

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