Healthcare Provider Details

I. General information

NPI: 1992452940
Provider Name (Legal Business Name): BABES ALLURE MEDICAL WIGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15001 KERCHEVAL AVE 452
GROSSE POINTE MI
48230
US

IV. Provider business mailing address

15001 KERCHEVAL AVE 452
GROSSE POINTE MI
48230
US

V. Phone/Fax

Practice location:
  • Phone: 586-648-0957
  • Fax:
Mailing address:
  • Phone: 586-648-0957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DOMINIQUE LEVY
Title or Position: CEO
Credential:
Phone: 586-648-0957