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NPI Code Detail

MEDICARE: KEISHON MIDCALF

MEDICARE: KEISHON MIDCALF
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1366397523
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEISHON MIDCALF
Provider Business Mailing Address
First Line : 3170 W CENTRAL AVE STE G
Second Line :
City : TOLEDO
State : OH
Zip : 43606-2945
Country : US
Telephone Number : 567-803-9706
Fax Number : 567-803-9706
Provider Business Practice Location Address
First Line : 3170 W CENTRAL AVE STE G
Second Line :
City : TOLEDO
State : OH
Zip : 43606-2945
Country : US
Telephone Number : 567-803-9706
Fax Number : 567-803-9706
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2026
Last Update Date : 03/03/2026

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Directions to “ KEISHON MIDCALF ” Practice Location

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