Doctor Name: | SHAUNTUN DICKERSON |
NPI Number: | 1134471279 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 1418 N 27th St Milwaukee, WI - 532082409 |
Business Phone Number: | 4143666269 |
Business Fax Number: | |
Mailing Address: | 1418 N 27th St, MILWAUKEE |
State: | WI |
Postal Code: | 532082409 |
Phone Number: | 4143666269 |
Fax Number: | |
NPI Enumeration Date: | 10/14/2012 |
NPI Last Update Date: | 10/14/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |