Healthcare Provider Details

I. General information

NPI: 1952129348
Provider Name (Legal Business Name): MICIL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2908 DORTMUND DR
BISMARCK ND
58504-3199
US

IV. Provider business mailing address

2908 DORTMUND DR
BISMARCK ND
58504-3199
US

V. Phone/Fax

Practice location:
  • Phone: 701-300-0758
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: AKINTUNDE IBIKUNLE
Title or Position: OWNER
Credential:
Phone: 701-300-0758