MEDICARE: MEKHI WILLIAM VON PARKER

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
1	172A00000X	Driver
2	376J00000X	Homemaker

General Provider Information

NPI Number	:	1497591770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEKHI WILLIAM VON PARKER

Provider Business Mailing Address
First Line	:	158 MEDFORD ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45410-2154
Country	:	US
Telephone Number	:	937-499-3774
Fax Number	:

Provider Business Practice Location Address
First Line	:	4740 EAGLEVIEW DR
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-5533
Country	:	US
Telephone Number	:	937-825-8531
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2024
Last Update Date	:	07/05/2024

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Directions to “ MEKHI WILLIAM VON PARKER ” Practice Location

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