Healthcare Provider Details

I. General information

NPI: 1649636036
Provider Name (Legal Business Name): LPM SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 N SAGINAW ST SUITE 801
PONTIAC MI
48342-2134
US

IV. Provider business mailing address

20760 DELAWARE ST
SOUTHFIELD MI
48033-3619
US

V. Phone/Fax

Practice location:
  • Phone: 248-292-2031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number04582Q
License Number StateMI

VIII. Authorized Official

Name: AMOS AJANI
Title or Position: PRESIDENT
Credential:
Phone: 248-292-2031