Derick T Mukom
NPI #1013892074 in Glenn Dale, Maryland
Provider Information
- NPI Number
- 1013892074
- Entity Type
- Individual
- Name
- Derick T Mukom
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Case Manager/Care Coordinator
- Enumeration Date
- Aug 8, 2025
- Last Updated
- Oct 23, 2025
Practice Location
- Address
- 6911 FOUNTAIN PARK DR
- City
- Glenn Dale
- State
- Maryland
- ZIP Code
- 20769-9484
- Phone
- (832) 988-8970
Specialties & Taxonomy Codes
| Specialty |
|---|
| Case Manager/Care Coordinator |
| Community Health Worker |
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