Healthcare Provider Details

I. General information

NPI: 1639315112
Provider Name (Legal Business Name): MIOTECH ORTHOPEDIC SALES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 01/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 OKEMOS RD SUITE 22
OKEMOS MI
48864-2819
US

IV. Provider business mailing address

4125 OKEMOS RD SUITE 22
OKEMOS MI
48864-2819
US

V. Phone/Fax

Practice location:
  • Phone: 517-347-0220
  • Fax: 517-347-0221
Mailing address:
  • Phone: 517-347-0220
  • Fax: 517-347-0221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. KENNETH MICHAEL ZISHOLZ
Title or Position: CEO
Credential:
Phone: 517-347-0220