Individual
TIDJANI MAOULOUD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2604 PINE VALLEY DR, CHAMPAIGN, IL 61822-7982
(260) 602-6110
Mailing address
2604 PINE VALLEY DR, CHAMPAIGN, IL 61822-7982
(260) 602-6110
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
05/30/2024
Last updated
05/30/2024
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