MEDICARE: MR. MICHAEL ODHIAMBO

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	374U00000X	Home Health Aide	HHA3846	DC

General Provider Information

NPI Number	:	1669875761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL ODHIAMBO

Provider Business Mailing Address
First Line	:	931 LONGFELLOW ST NW
Second Line	:	APT B7
City	:	WASHINGTON
State	:	DC
Zip	:	20011-8237
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6856 EASTERN AVE NW
Second Line	:	220
City	:	WASHINGTON
State	:	DC
Zip	:	20012-2165
Country	:	US
Telephone Number	:	202-545-6980
Fax Number	:

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

Provider Enumeration Date	:	10/02/2014
Last Update Date	:	10/02/2014

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