MEDICARE: PANACEA THERAPEUTIC SOLUTIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1013540202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PANACEA THERAPEUTIC SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	3815 W FORT ST STE 207
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48216-1652
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3815 W FORT ST STE 207
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48216-1652
Country	:	US
Telephone Number	:	734-260-7453
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEVE ZAR
Credential	:
Telephone Number	:	734-260-7453

Provider Enumeration Date	:	02/17/2020
Last Update Date	:	02/17/2020

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