| Kouekam Llc | |
|
11973 Beltsville Dr Beltsville MD 20705-4004 | |
| (240) 581-2625 | |
| Not Available |
| Full Name | Kouekam Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 11973 Beltsville Dr, Beltsville, Maryland |
| Authorized Official Name and Position | Doris Tioko (PROVIDER) |
| Authorized Official Contact | 2405812625 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kouekam Llc 11973 Beltsville Dr Beltsville MD 20705-4004 Ph: (240) 581-2625 | Kouekam Llc 11973 Beltsville Dr Beltsville MD 20705-4004 Ph: (240) 581-2625 |
| NPI Number | 1366208258 |
|---|---|
| Provider Enumeration Date | 02/27/2024 |
| Last Update Date | 02/27/2024 |
| Certification Date | 02/27/2024 |
| Medicare PECOS PAC ID | 4385080258 |
|---|---|
| Medicare Enrollment ID | O20240313003987 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366208258 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Doris Tioko |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639430432 PECOS PAC ID: 5294171161 Enrollment ID: I20240313004220 |
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