MEDICARE: LAKISHA K MICHEL COSMETOLOGIST

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	224P00000X	Prosthetist	1204019125	VI

General Provider Information

NPI Number	:	1972399491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKISHA K MICHEL COSMETOLOGIST

Provider Business Mailing Address
First Line	:	1739 PARKVIEW DR
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-2630
Country	:	US
Telephone Number	:	757-706-2245
Fax Number	:

Provider Business Practice Location Address
First Line	:	1739 PARKVIEW DR
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-2630
Country	:	US
Telephone Number	:	757-706-2245
Fax Number	:

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

Provider Enumeration Date	:	04/21/2025
Last Update Date	:	04/21/2025

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