Individual
MS. TIERRA C LUKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
23555 BRANDYWYNNE ST, SOUTHFIELD, MI 48033-2952
(313) 673-2151
Mailing address
23555 BRANDYWYNNE ST, SOUTHFIELD, MI 48033-2952
(313) 673-2151
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
247200000
TECHNICIAN
—
Enumeration date
06/03/2016
Last updated
06/03/2016
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