MEDICARE: MICHEL MARIEN KENGNE TANEKOU

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	106S00000X	Behavior Technician
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1811705460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHEL MARIEN KENGNE TANEKOU

Provider Business Mailing Address
First Line	:	4121 WARNER AVE APT D4
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-1953
Country	:	US
Telephone Number	:	202-582-9077
Fax Number	:

Provider Business Practice Location Address
First Line	:	4121 WARNER AVE APT D4
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-1953
Country	:	US
Telephone Number	:	202-582-9077
Fax Number	:

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

Provider Enumeration Date	:	12/27/2024
Last Update Date	:	03/02/2026

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