MEDICARE: VONDILA K DUMAS N/A

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	390200000X	Student in an Organized Health Care Education/Training Program
2	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1558258814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VONDILA K DUMAS N/A

Provider Business Mailing Address
First Line	:	8117 PRESSLER ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48213-2364
Country	:	US
Telephone Number	:	586-421-6736
Fax Number	:

Provider Business Practice Location Address
First Line	:	8117 PRESSLER ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48213-2364
Country	:	US
Telephone Number	:	586-421-6736
Fax Number	:

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

Provider Enumeration Date	:	06/19/2025
Last Update Date	:	07/09/2025

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