Provider Demographics
NPI:1912602285
Name:MEDICINA SCARLETT LLC
Entity type:Organization
Organization Name:MEDICINA SCARLETT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCARLETT
Authorized Official - Middle Name:
Authorized Official - Last Name:IDEMA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:917-885-5670
Mailing Address - Street 1:2932 ELMHURST AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3099
Mailing Address - Country:US
Mailing Address - Phone:917-885-5670
Mailing Address - Fax:
Practice Address - Street 1:8631 W VERNOR HWY STE B1A
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-3420
Practice Address - Country:US
Practice Address - Phone:917-885-5670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-04
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty