Healthcare Provider Details

I. General information

NPI: 1730710559
Provider Name (Legal Business Name): MI-CHA-EL B WEST JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E 25TH ST
BALTIMORE MD
21218-5213
US

IV. Provider business mailing address

107 E 25TH ST
BALTIMORE MD
21218-5213
US

V. Phone/Fax

Practice location:
  • Phone: 410-558-0032
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: