Provider Demographics
NPI:1609479518
Name:SPRATT, LAKEEVA MICHELLE
Entity Type:Individual
Prefix:
First Name:LAKEEVA
Middle Name:MICHELLE
Last Name:SPRATT
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 1:9609 WARWICK ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-1322
Mailing Address - Country:US
Mailing Address - Phone:248-688-5768
Mailing Address - Fax:
Practice Address - Street 1:9609 WARWICK ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-1322
Practice Address - Country:US
Practice Address - Phone:248-688-5768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI9435011251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9435011Medicaid