MEDICARE: COVID CARE ZONE INC

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1851044010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COVID CARE ZONE INC

Provider Business Mailing Address
First Line	:	5801 WASHINGTON AVE STE 203
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53406-4057
Country	:	US
Telephone Number	:	224-607-4428
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 WASHINGTON AVE STE 203
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53406-4057
Country	:	US
Telephone Number	:	224-607-4428
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MOHAMMED INFAS ABDUL RAHMAN
Credential	:
Telephone Number	:	224-607-4428

Provider Enumeration Date	:	01/28/2022
Last Update Date	:	01/28/2022

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