MEDICARE: EXECUTIVE INFUSION SERVICES 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	333600000X	Pharmacy
2	251F00000X	Home Infusion Agency
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	3336C0003X	Community/Retail Pharmacy
5	3336C0004X	Compounding Pharmacy
6	3336H0001X	Home Infusion Therapy Pharmacy	5301010096	MI
7	3336S0011X	Specialty Pharmacy
8	261QI0500X	Infusion Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2135839	OTHER		PK

General Provider Information

NPI Number	:	1245591338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXECUTIVE INFUSION SERVICES LLC

Provider Business Mailing Address
First Line	:	17000 EXECUTIVE PLAZA DR
Second Line	:	SUITE 201
City	:	DEARBORN
State	:	MI
Zip	:	48126-2793
Country	:	US
Telephone Number	:	313-982-3220
Fax Number	:	313-982-3221

Provider Business Practice Location Address
First Line	:	17000 EXECUTIVE PLAZA DR
Second Line	:	SUITE 201
City	:	DEARBORN
State	:	MI
Zip	:	48126-2793
Country	:	US
Telephone Number	:	313-982-3220
Fax Number	:	313-982-3221

Authorized Official
Title or Position	:	OWNER
Name	:	AIMAN ABUEIDA
Credential	:
Telephone Number	:	313-523-5334

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	05/09/2024

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Directions to “EXECUTIVE INFUSION SERVICES LLC ” Practice Location

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