Provider Demographics
NPI:1821778036
Name:MCCORD, MONTRAIL
Entity Type:Individual
Prefix:
First Name:MONTRAIL
Middle Name:
Last Name:MCCORD
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 1:19429 CONLEY ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-2249
Mailing Address - Country:US
Mailing Address - Phone:313-772-0731
Mailing Address - Fax:
Practice Address - Street 1:19429 CONLEY ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-2249
Practice Address - Country:US
Practice Address - Phone:313-772-0731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health