Healthcare Provider Details

I. General information

NPI: 1891874533
Provider Name (Legal Business Name): MT CLEMENS MEDICAL EQUIPMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38530 GROESBECK HWY
CLINTON TWP MI
48036
US

IV. Provider business mailing address

53990 FOSTER ROAD NORTH
CHESTERFIELD MI
48051
US

V. Phone/Fax

Practice location:
  • Phone: 586-463-6620
  • Fax: 586-468-4278
Mailing address:
  • Phone: 586-463-6620
  • Fax: 586-468-4278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHERRI K WISHAW
Title or Position: OWNER
Credential: COFM
Phone: 586-463-6620