Provider Demographics
NPI:1528224102
Name:MCDONALD, JOVON MALIK
Entity Type:Individual
Prefix:MR
First Name:JOVON
Middle Name:MALIK
Last Name:MCDONALD
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 1:19901 TERRACE AVE
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60411-1309
Mailing Address - Country:US
Mailing Address - Phone:773-858-7378
Mailing Address - Fax:708-251-5060
Practice Address - Street 1:19901 TERRACE AVE
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60411-1309
Practice Address - Country:US
Practice Address - Phone:773-858-7378
Practice Address - Fax:708-251-5060
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILM23543381018343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)