Individual
MR. DEMONTERRYO L BLACK SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
6652 N TOWNE RD APT 121, WINDSOR, WI 53598-9130
(608) 906-4343
Mailing address
1173 OKEEFFE AVE, SUN PRAIRIE, WI 53590-4236
(608) 906-4343
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
06/09/2021
Last updated
06/17/2021
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