Healthcare Provider Details

I. General information

NPI: 1417875014
Provider Name (Legal Business Name): MARIO RAMONE LINGARD VENDOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2368 WHALEN ST # 2368
HAMTRAMCK MI
48212-4056
US

IV. Provider business mailing address

2368 WHALEN ST # 2368
HAMTRAMCK MI
48212-4056
US

V. Phone/Fax

Practice location:
  • Phone: 313-279-7281
  • Fax:
Mailing address:
  • Phone: 313-279-7281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: