Provider Demographics
NPI:1821746389
Name:FRITH, TKILA MARIA
Entity Type:Individual
Prefix:
First Name:TKILA
Middle Name:MARIA
Last Name:FRITH
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 1:16061 E 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-2547
Mailing Address - Country:US
Mailing Address - Phone:313-459-1266
Mailing Address - Fax:
Practice Address - Street 1:1101 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-3613
Practice Address - Country:US
Practice Address - Phone:313-784-3650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health