| T L Sea LLC | |
|
15201 W Mcnichols Rd Detroit MI 48235-3717 | |
| (313) 516-3142 | |
| Not Available |
| Full Name | T L Sea LLC |
|---|---|
| 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 |
|---|---|
| T L Sea LLC 3500 E Jefferson Ave Apt 329 Detroit MI 48207-4396 | T L Sea LLC 15201 W Mcnichols Rd Detroit MI 48235-3717 Ph: (313) 516-3142 |
| NPI Number | 1023673910 |
|---|---|
| Provider Enumeration Date | 05/06/2019 |
| Last Update Date | 05/06/2019 |
| Medicare PECOS PAC ID | 9436482353 |
|---|---|
| Medicare Enrollment ID | O20190610000276 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023673910 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (NU) | Primary |
| Provider Name | Tonya Collins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275957185 PECOS PAC ID: 3375883408 Enrollment ID: I20190327000900 |
| Provider Name | Marcia a Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881310225 PECOS PAC ID: 8628549896 Enrollment ID: I20260609000690 |
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