Provider Demographics
NPI:1265021414
Name:AJIDE, MISHAEL
Entity Type:Individual
Prefix:
First Name:MISHAEL
Middle Name:
Last Name:AJIDE
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:PO BOX 3032
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-3032
Mailing Address - Country:US
Mailing Address - Phone:713-319-6193
Mailing Address - Fax:
Practice Address - Street 1:3968 CHESAPEAKE LN
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-2654
Practice Address - Country:US
Practice Address - Phone:713-319-6193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)