Healthcare Provider Details

I. General information

NPI: 1033299599
Provider Name (Legal Business Name): MARIE PITKO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42524 HAYES RD STE 300
CLINTON TWP MI
48038-3643
US

IV. Provider business mailing address

42524 HAYES RD STE 300
CLINTON TWP MI
48038-3643
US

V. Phone/Fax

Practice location:
  • Phone: 586-228-9740
  • Fax: 586-286-1507
Mailing address:
  • Phone: 586-228-9740
  • Fax: 586-286-1507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMI

VIII. Authorized Official

Name: MARIE PITKO
Title or Position: OWNER
Credential: OPTICIAN
Phone: 586-228-9740