T L Sea Llc | |
15201 W Mcnichols Rd Detroit MI 48235-3717 | |
(313) 516-3142 | |
Not Available |
Full Name | T L Sea Llc |
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Speciality | Clinic/Center |
Location | 15201 W Mcnichols Rd, Detroit, Michigan |
Authorized Official Name and Position | Tonya Collins (CEO) |
Authorized Official Contact | 3135163142 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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T L Sea Llc 3500 E Jefferson Ave Apt 329 Detroit MI 48207-4396 Ph: () - | T L Sea Llc 15201 W Mcnichols Rd Detroit MI 48235-3717 Ph: (313) 516-3142 |
NPI Number | 1023673910 |
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Provider Enumeration Date | 05/06/2019 |
Last Update Date | 05/06/2019 |
Medicare PECOS PAC ID | 9436482353 |
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Medicare Enrollment ID | O20190610000276 |
Identifier | Type | State | Issuer |
---|---|---|---|
1023673910 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Tonya Renee Collins-pickett |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1275957185 PECOS PAC ID: 3375883408 Enrollment ID: I20190327000900 |
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