Individual
MARK ESIYEDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1407 1/2 CHICAGO STREET, 4, VALPARAISO, IN 46383
(219) 707-3767
Mailing address
1407 1/2 CHICAGO STREET, 4, VALPARAISO, IN 46383
(219) 707-3767
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
4420277588
IN
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
344600000X
Taxi
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4420277588
DRIVERS LICENCE
IN
Enumeration date
02/06/2019
Last updated
02/06/2019
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