MEDICARE: TEKIVAN GROUP, 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1922689827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEKIVAN GROUP, INC.

Provider Business Mailing Address
First Line	:	4152 DALE BLVD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-2225
Country	:	US
Telephone Number	:	240-988-3818
Fax Number	:

Provider Business Practice Location Address
First Line	:	4152 DALE BLVD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-2225
Country	:	US
Telephone Number	:	240-988-3818
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KEHINDE AWOSIKA
Credential	:
Telephone Number	:	703-721-8166

Provider Enumeration Date	:	04/21/2021
Last Update Date	:	01/03/2022

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Directions to “TEKIVAN GROUP, INC. ” Practice Location

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