Healthcare Provider Details

I. General information

NPI: 1467454959
Provider Name (Legal Business Name): PROSTHETIC CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S WASHINGTON AVE
LANSING MI
48910-1651
US

IV. Provider business mailing address

1200 S WASHINGTON AVE
LANSING MI
48910-1651
US

V. Phone/Fax

Practice location:
  • Phone: 517-372-7007
  • Fax: 517-372-0261
Mailing address:
  • Phone: 517-372-7007
  • Fax: 517-372-0261

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: MR. RONALD W. JUNTTONEN
Title or Position: PRESIDENT
Credential: C.P.
Phone: 517-372-7007