MEDICARE: DUANE CROSS

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	347E00000X	Transportation Broker	1715308	OH

General Provider Information

NPI Number	:	1487123808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUANE CROSS

Provider Business Mailing Address
First Line	:	3370 GIBRALTER HEIGHTS DR APT B5
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43609-1256
Country	:	US
Telephone Number	:	419-973-9097
Fax Number	:

Provider Business Practice Location Address
First Line	:	3370 GIBRALTER HEIGHTS DR APT B5
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43609-1256
Country	:	US
Telephone Number	:	419-973-9097
Fax Number	:

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

Provider Enumeration Date	:	11/14/2018
Last Update Date	:	11/14/2018

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Directions to “ DUANE CROSS ” Practice Location

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