Organization
MD TRICHOLOGY LLC
Active
Organization
MD TRICHOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARQUITA DANIEL BCHHP (TRICHOLOGIST)
(219) 595-0566
Entity
Organization
Contact information
Practice address
1630 45TH ST # B101, MUNSTER, IN 46321-3963
(219) 595-0566
Mailing address
1630 45TH ST # B101, MUNSTER, IN 46321-3963
(219) 595-0566
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
07/24/2023
Last updated
07/24/2023
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