Healthcare Provider Details

I. General information

NPI: 1629200159
Provider Name (Legal Business Name): DESIGNED ALTOBARIC TECHNOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21800 PONTIAC TRL
SOUTH LYON MI
48178-9499
US

IV. Provider business mailing address

3061 CHRISTY WAY
SAGINAW MI
48603-2267
US

V. Phone/Fax

Practice location:
  • Phone: 248-486-3636
  • Fax:
Mailing address:
  • Phone: 989-791-2455
  • Fax: 989-791-1392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301089220
License Number StateMI

VIII. Authorized Official

Name: STEPHEN D GUTHRIE
Title or Position: PHD
Credential: MD
Phone: 248-486-3636