Healthcare Provider Details

I. General information

NPI: 1790470540
Provider Name (Legal Business Name): MICHEAL KUNE NJOHJAM BSC MICROBIOLOGY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 04/07/2023
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5110 54TH AVE APT 1
HYATTSVILLE MD
20781-2803
US

IV. Provider business mailing address

5110 54TH AVE APT 1
HYATTSVILLE MD
20781-2803
US

V. Phone/Fax

Practice location:
  • Phone: 240-709-0451
  • Fax:
Mailing address:
  • Phone: 240-709-0451
  • 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: