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General NPI Number Information
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NPI Number | 1699653451
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Entity Type | Individual
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Provider Name | MINKAILOU SOUMAH
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Gender | Male
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Dates
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Enumeration Date | 08/21/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 7211 PARK HEIGHTS AVE
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City | PIKESVILLE
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State | MD
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Zip | 21208-5403
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Country | US
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Telephone | 443-759-8965
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Fax |
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Provider Business Mailing Address
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Address Line | 4540 OLD COURT RD
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City | PIKESVILLE
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State | MD
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Zip | 21208-2430
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Country | US
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Telephone | 227-215-8987
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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