MEDICARE: MONTEL LOVE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1275379265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONTEL LOVE

Provider Business Mailing Address
First Line	:	3890 W JEFFERSON AVE
Second Line	:
City	:	ECORSE
State	:	MI
Zip	:	48229-1741
Country	:	US
Telephone Number	:	313-899-0043
Fax Number	:

Provider Business Practice Location Address
First Line	:	3890 W JEFFERSON AVE
Second Line	:
City	:	ECORSE
State	:	MI
Zip	:	48229-1741
Country	:	US
Telephone Number	:	313-383-3928
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2024
Last Update Date	:	07/08/2024

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Directions to “ MONTEL LOVE ” Practice Location

Language	Start Address	Practice Location

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