MEDICARE: AFIAVI DADO

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	343900000X	Non-emergency Medical Transport (VAN)	L10074	MI

General Provider Information

NPI Number	:	1821415001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AFIAVI DADO

Provider Business Mailing Address
First Line	:	15045 MANNING ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48205-1969
Country	:	US
Telephone Number	:	248-508-9112
Fax Number	:

Provider Business Practice Location Address
First Line	:	15045 MANNING ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48205-1969
Country	:	US
Telephone Number	:	248-508-9112
Fax Number	:

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

Provider Enumeration Date	:	03/25/2014
Last Update Date	:	03/25/2014

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Directions to “ AFIAVI DADO ” Practice Location

Language	Start Address	Practice Location

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