Lydell Jamal Henderson
Individual provider Active NPI Driver · Southfield, MI
NPI 1982139671 · NPPES record last updated May 1, 2017
Key facts
- NPI
- 1982139671
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- Practice address
- 24333 Southfield Rd
Ste. 212
Southfield, MI 48075-2822 - Phone
- (248) 587-7867
- NPI assigned
- May 1, 2017
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | Yes |
Addresses
Primary practice location
24333 Southfield Rd
Ste. 212
Southfield, MI 48075-2822
Mailing address
24333 Southfield Rd
Ste. 212
Southfield, MI 48075-2822
Phone (248) 587-7867
Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 1, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.