MEDICARE: DEREK DENSON

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	:	1518639863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK DENSON

Provider Business Mailing Address
First Line	:	4800 S LAKE PARK AVE APT 306
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-2044
Country	:	US
Telephone Number	:	773-580-5899
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 S LAKE PARK AVE APT 306
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-2044
Country	:	US
Telephone Number	:	773-580-5899
Fax Number	:

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

Provider Enumeration Date	:	10/04/2021
Last Update Date	:	10/04/2021

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Directions to “ DEREK DENSON ” Practice Location

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