Provider Demographics
NPI:1346692415
Name:BAYNES, MIRACLE
Entity Type:Individual
Prefix:
First Name:MIRACLE
Middle Name:
Last Name:BAYNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35875 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-4033
Mailing Address - Country:US
Mailing Address - Phone:313-407-0334
Mailing Address - Fax:
Practice Address - Street 1:35875 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-4033
Practice Address - Country:US
Practice Address - Phone:313-407-0334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other