MEDICARE: TODAE CHARLES

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1902344245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODAE CHARLES

Provider Business Mailing Address
First Line	:	PO BOX 3072
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75123-3072
Country	:	US
Telephone Number	:	972-408-7423
Fax Number	:

Provider Business Practice Location Address
First Line	:	2932 GLADIOLUS LANE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75233
Country	:	US
Telephone Number	:	972-408-7423
Fax Number	:

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

Provider Enumeration Date	:	02/07/2017
Last Update Date	:	02/07/2017

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Directions to “ TODAE CHARLES ” Practice Location

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