Individual
MRS. SHAVONN BURKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16193 CRUSE ST, DETROIT, MI 48235-4002
(313) 646-0065
Mailing address
16193 CRUSE ST, DETROIT, MI 48235-4002
(313) 646-0065
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
L146765139011
MI
Other
Enumeration date
09/28/2021
Last updated
09/28/2021
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