Provider Demographics
NPI:1174229280
Name:MUHAMMAD, MELCHEZIDEK KENNY
Entity type:Individual
Prefix:MR
First Name:MELCHEZIDEK
Middle Name:KENNY
Last Name:MUHAMMAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15225 LUCKNOW AVE # DN
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-1737
Mailing Address - Country:US
Mailing Address - Phone:216-450-2195
Mailing Address - Fax:
Practice Address - Street 1:15225 LUCKNOW AVE # DN
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-1737
Practice Address - Country:US
Practice Address - Phone:216-450-2195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRJ650092343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)