Provider Demographics
NPI:1730575259
Name:BOYCE, DEANGELO
Entity type:Individual
Prefix:
First Name:DEANGELO
Middle Name:
Last Name:BOYCE
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 1:18851 NORBORNE
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-1812
Mailing Address - Country:US
Mailing Address - Phone:313-753-7657
Mailing Address - Fax:
Practice Address - Street 1:18851 NORBORNE
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-1812
Practice Address - Country:US
Practice Address - Phone:313-753-7657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
No347C00000XTransportation ServicesPrivate Vehicle