Healthcare Provider Details

I. General information

NPI: 1417873639
Provider Name (Legal Business Name): ZZ MEDISOURCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24901 NORTHWESTERN HWY
SOUTHFIELD MI
48075-2203
US

IV. Provider business mailing address

24901 NORTHWESTERN HWY
SOUTHFIELD MI
48075-2203
US

V. Phone/Fax

Practice location:
  • Phone: 888-910-0640
  • Fax: 888-804-0426
Mailing address:
  • Phone: 888-910-0640
  • Fax: 888-804-0426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN CANDICE
Title or Position: MANAGER
Credential:
Phone: 888-910-0640