Healthcare Provider Details

I. General information

NPI: 1699509323
Provider Name (Legal Business Name): PROSTHETIC ARTISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N 5TH AVE STE 130
ANN ARBOR MI
48104-1447
US

IV. Provider business mailing address

300 N 5TH AVE STE 130
ANN ARBOR MI
48104-1447
US

V. Phone/Fax

Practice location:
  • Phone: 916-485-4249
  • Fax: 734-800-3723
Mailing address:
  • Phone: 916-485-4249
  • Fax: 734-800-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: ERIC MATTHEW LINDSEY
Title or Position: CEO
Credential: BCO
Phone: 916-485-4249