Healthcare Provider Details

I. General information

NPI: 1659934669
Provider Name (Legal Business Name): JEFFREY PAUL CATES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 W 11 MILE RD
MADISON HEIGHTS MI
48071-3102
US

IV. Provider business mailing address

PO BOX 1379
ROYAL OAK MI
48068-1379
US

V. Phone/Fax

Practice location:
  • Phone: 248-246-1669
  • Fax:
Mailing address:
  • Phone: 248-246-1669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number2102185764
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2102185764
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number2102185764
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number2102185764
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: