Provider Demographics
NPI:1356082630
Name:PRATT, MIKAAL
Entity type:Individual
Prefix:
First Name:MIKAAL
Middle Name:
Last Name:PRATT
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 1:4811 GERMANTOWN AVE # 304
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-3014
Mailing Address - Country:US
Mailing Address - Phone:267-693-6777
Mailing Address - Fax:
Practice Address - Street 1:4811 GERMANTOWN AVE # 304
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-3014
Practice Address - Country:US
Practice Address - Phone:267-693-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-02
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)