MEDICARE: MANE MEDIC HAIR REJUVENATION LLC

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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1851957872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANE MEDIC HAIR REJUVENATION LLC

Provider Business Mailing Address
First Line	:	2120 N REYNOLDS RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-3514
Country	:	US
Telephone Number	:	419-407-5595
Fax Number	:

Provider Business Practice Location Address
First Line	:	2120 N REYNOLDS RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-3514
Country	:	US
Telephone Number	:	419-407-5595
Fax Number	:

Authorized Official
Title or Position	:	PROSTHETIC ORTHOTIC SUPPLIER
Name	:	TIMIKO KINER
Credential	:
Telephone Number	:	419-690-5617

Provider Enumeration Date	:	05/15/2019
Last Update Date	:	04/25/2023

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