Provider Demographics
NPI:1811943947
Name:DALLAH MEDCARE SERVICES, INC.
Entity type:Organization
Organization Name:DALLAH MEDCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JIDEOFOR
Authorized Official - Middle Name:NNAEMEKA
Authorized Official - Last Name:DALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-717-6301
Mailing Address - Street 1:19785 W 12 MILE RD
Mailing Address - Street 2:SUITE 488
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2584
Mailing Address - Country:US
Mailing Address - Phone:248-582-9755
Mailing Address - Fax:
Practice Address - Street 1:28350 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4208
Practice Address - Country:US
Practice Address - Phone:734-717-6301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies