MEDICARE: MICHAEL DAVID JEFFREY

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	253Z00000X	In Home Supportive Care Agency
2	376J00000X	Homemaker

General Provider Information

NPI Number	:	1649921388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DAVID JEFFREY

Provider Business Mailing Address
First Line	:	1552 MALASIA RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44305-3570
Country	:	US
Telephone Number	:	330-388-3179
Fax Number	:

Provider Business Practice Location Address
First Line	:	1552 MALASIA RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44305-3570
Country	:	US
Telephone Number	:	330-388-3179
Fax Number	:

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

Provider Enumeration Date	:	01/14/2022
Last Update Date	:	01/14/2022

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