Healthcare Provider Details

I. General information

NPI: 1033933809
Provider Name (Legal Business Name): THE CREATIVE MOBILITY GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32217 STEPHENSON HWY
MADISON HEIGHTS MI
48071-5519
US

IV. Provider business mailing address

32217 STEPHENSON HWY
MADISON HEIGHTS MI
48071-5519
US

V. Phone/Fax

Practice location:
  • Phone: 248-577-5430
  • Fax: 248-577-5450
Mailing address:
  • Phone: 248-577-5430
  • Fax: 248-577-5450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: THOMAS JONATHAN STOWERS
Title or Position: OWNER
Credential:
Phone: 734-595-4400