| Detroit Area Agency On Aging | |
|
1333 Brewery Park Blvd Ste 200 Detroit MI 48207-4544 | |
| (313) 446-4444 | |
| (313) 446-4451 |
| Full Name | Detroit Area Agency On Aging |
|---|---|
| Speciality | Internal Medicine |
| Location | 1333 Brewery Park Blvd Ste 200, Detroit, Michigan |
| Authorized Official Name and Position | Wanda Patrice Bowman (DIRECTOR OF FINANCE) |
| Authorized Official Contact | 3134464444 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Detroit Area Agency On Aging 1333 Brewery Park Blvd Ste 200 Detroit MI 48207-4544 Ph: (313) 446-4444 | Detroit Area Agency On Aging 1333 Brewery Park Blvd Ste 200 Detroit MI 48207-4544 Ph: (313) 446-4444 |
| NPI Number | 1134725427 |
|---|---|
| Provider Enumeration Date | 12/10/2020 |
| Last Update Date | 12/10/2020 |
| Medicare PECOS PAC ID | 1850527854 |
|---|---|
| Medicare Enrollment ID | O20131121001566 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134725427 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Anthony W Clarke |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811055858 PECOS PAC ID: 4880618453 Enrollment ID: I20100520000661 |
| Provider Name | Marie Shoulders-williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851547038 PECOS PAC ID: 9830468461 Enrollment ID: I20170712003843 |
| Provider Name | Donnietra La'verne Walls |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710654744 PECOS PAC ID: 1456727817 Enrollment ID: I20221026002400 |
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