Individual
MR. SILAS KFUSALU WAINDIM SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MR
Contact information
Practice address
8923 GREYSTONE AVE S, COTTAGE GROVE, MN 55016-2761
(651) 304-0541
Mailing address
8923 GREYSTONE AVE S, COTTAGE GROVE, MN 55016-2761
(651) 304-0541
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
USDOT2493341
MN
Other
Enumeration date
07/22/2014
Last updated
07/22/2014
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