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Individual

DERRICK LASHAWN SANDLES

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
9218 N 60TH ST, MILWAUKEE, WI 53223-1502
(262) 349-6839
Mailing address
9218 N 60TH ST, MILWAUKEE, WI 53223-1502
(262) 349-6839

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
WI

Other

Enumeration date
03/03/2025
Last updated
03/03/2025
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