Individual
EDISON KONAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
15450 HEATHERWOOD, SOUTHGATE, MI 48195-8523
(734) 720-2097
Mailing address
15450 HEATHERWOOD, SOUTHGATE, MI 48195-8523
(734) 720-2097
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
171400000X
Health & Wellness Coach
—
—
172A00000X
Driver
—
—
225700000X
Massage Therapist
Primary
7501016017
MI
372600000X
Adult Companion
—
—
Other
Enumeration date
12/06/2022
Last updated
01/08/2024
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