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General NPI Number Information
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NPI Number | 1669969903
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Entity Type | Organization
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Legal Business Name | EVOLUTION HAIR COMPANY LLC
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Dates
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Enumeration Date | 04/20/2018
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 17825 W 7 MILE RD
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City | DETROIT
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State | MI
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Zip | 48235-3052
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Country | US
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Telephone | 313-693-9722
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Fax |
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Provider Business Mailing Address
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Address Line | 17825 W 7 MILE RD
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City | DETROIT
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State | MI
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Zip | 48235-3052
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEFFERY L HUDSON
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Credential |
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Telephone | 313-282-5654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State | MI
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