Individual
DEMARTEZ LAMAR COUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1474 CHATHAM DR., SAGINAW, MI 48601
(989) 401-6502
Mailing address
1474 CHATHAM DR, SAGINAW, MI 48601-5116
(989) 401-6502
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
007496483
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7496483
HOME HELP PROVIDER NUMBER
—
Enumeration date
11/24/2015
Last updated
11/24/2015
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