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NPI Code Detail

MEDICARE: KEVIN DANIEL ACC

MEDICARE:   KEVIN  DANIEL  ACC
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
1324500000XSubstance Abuse Rehabilitation Facility

General Provider Information

NPI Number : 1124237862
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN DANIEL ACC
Provider Business Mailing Address
First Line : 15856 PARKSIDE ST
Second Line :
City : DETROIT
State : MI
Zip : 48238-4104
Country : US
Telephone Number : 313-334-2559
Fax Number :
Provider Business Practice Location Address
First Line : 12010 LINWOOD ST
Second Line :
City : DETROIT
State : MI
Zip : 48206-1108
Country : US
Telephone Number : 313-867-1090
Fax Number : 313-867-0706
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2007
Last Update Date : 07/08/2007

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Directions to “ KEVIN DANIEL ACC” Practice Location

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