Individual
MICHE CLEMENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
209 S HALIFAX AVE, DAYTONA BEACH, FL 32118-6814
(954) 471-1771
Mailing address
PO BOX 11502, DAYTONA BEACH, FL 32120-1502
(954) 471-1771
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81-1179377
—
FL
Enumeration date
05/31/2018
Last updated
05/31/2018
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