Individual
MRS. LAKISHA JEANETTE BURTON WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MBA, M.D.
Contact information
Practice address
540 E CANFIELD ST, DETROIT, MI 48201-1928
(313) 577-1102
Mailing address
4188 OLD DOMINION DR, WEST BLOOMFIELD, MI 48323-2659
(313) 701-8811
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
4301188560
MI
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/25/2015
Last updated
02/23/2016
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