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General NPI Number Information
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NPI Number | 1942187760
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Entity Type | Individual
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Provider Name | MR. OLIVER D KING II
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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 | 15762 ASHTON RD
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City | DETROIT
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State | MI
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Zip | 48223-1304
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Country | US
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Telephone | 313-747-5208
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Fax |
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Provider Business Mailing Address
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Address Line | 4206 MCCLELLAN ST
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City | DETROIT
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State | MI
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Zip | 48214-1373
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Country | US
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Telephone | 517-377-7728
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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 | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number |
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License Number State |
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