MEDICARE: MS. DEIDRE FLOWERS

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	247200000X	Other Technician
2	247200000X	Other Technician		MI

General Provider Information

NPI Number	:	1871071647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEIDRE FLOWERS

Provider Business Mailing Address
First Line	:	6776 STAHELIN AVE # 23
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48228-3465
Country	:	US
Telephone Number	:	313-346-3566
Fax Number	:

Provider Business Practice Location Address
First Line	:	6776 STAHELIN AVE # 23
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48228-3465
Country	:	US
Telephone Number	:	313-346-3566
Fax Number	:

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

Provider Enumeration Date	:	08/02/2018
Last Update Date	:	08/02/2018

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Directions to “ MS. DEIDRE FLOWERS ” Practice Location

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