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Individual

MR. CLYDE MILTON LOCKETT JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1251 N EDDY ST STE 200, SOUTH BEND, IN 46617-1478
(219) 312-1020
Mailing address
PO BOX 312, CROWN POINT, IN 46308-0312

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
172A00000X
Driver

Other

Enumeration date
09/01/2021
Last updated
09/01/2021
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