MEDICARE: GLINDA S DOTSON HAIR LOSS SPECIALIST

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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1689268526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLINDA S DOTSON HAIR LOSS SPECIALIST

Provider Business Mailing Address
First Line	:	5110 N 62ND ST # A
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-4119
Country	:	US
Telephone Number	:	414-551-9047
Fax Number	:

Provider Business Practice Location Address
First Line	:	5110 N 62ND ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-4119
Country	:	US
Telephone Number	:	414-551-9047
Fax Number	:

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

Provider Enumeration Date	:	02/22/2021
Last Update Date	:	02/22/2021

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