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NPI Code Detail

MEDICARE: MRS. DENISE MICHELLE STROM COSMETOLOGIST

MEDICARE: MRS. DENISE MICHELLE STROM COSMETOLOGIST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

General Provider Information

NPI Number : 1053819458
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DENISE MICHELLE STROM COSMETOLOGIST
Provider Business Mailing Address
First Line : 8620 PURDUE RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-1114
Country : US
Telephone Number : 317-879-6653
Fax Number :
Provider Business Practice Location Address
First Line : 8620 PURDUE RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-1114
Country : US
Telephone Number : 317-879-5563
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2018
Last Update Date : 01/31/2018

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Directions to “ MRS. DENISE MICHELLE STROM COSMETOLOGIST” Practice Location

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