Lydell Jamal Henderson
Driver in Southfield, MI. Individual provider (NPI-1).
NPI number1982139671
StatusActive
Last updated in NPPESMay 1, 2017
Details
- NPI
- 1982139671
- Entity type
- Individual (NPI-1)
- Name
- Mr. Lydell Jamal Henderson
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 1, 2017
- Last updated
- May 1, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 172A00000X | Driver | – | – | Yes |
Practice location
24333 Southfield RdSte. 212
Southfield, MI 48075-2822
Phone 248-587-7867
Mailing address
24333 Southfield RdSte. 212
Southfield, MI 48075-2822
Phone 248-587-7867
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