Individual
MS. KETIWE H MSIPHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SWT
Contact information
Practice address
2051 W GRAND BLVD, DETROIT, MI 48208-1105
(313) 961-3700
(313) 961-3769
Mailing address
2051 W GRAND BLVD, DETROIT, MI 48208-1105
(313) 961-3700
(313) 961-3769
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
6802084028
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6802084028
STATE LICENSE NUMBER
MI
Enumeration date
10/02/2006
Last updated
07/08/2007
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