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General NPI Number Information
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NPI Number | 1285442178
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Entity Type | Individual
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Provider Name | DECLAN C MGBUDEM
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Gender | Male
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Dates
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Enumeration Date | 12/23/2024
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 17403 HARVARD AVE
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City | CLEVELAND
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State | OH
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Zip | 44128-1715
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Country | US
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Telephone | 234-389-2121
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Fax |
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Provider Business Mailing Address
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Address Line | 10449 TOWNLEY CT
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City | REMINDERVILLE
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State | OH
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Zip | 44202-8152
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Country | US
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Telephone | 234-389-2121
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | SS802996
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License Number State | OH
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