Healthcare Provider Details

I. General information

NPI: 1861475451
Provider Name (Legal Business Name): BIO-MEDICAL APPLICATIONS OF MICHIGAN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22970 NORTHLINE RD STE 100
TAYLOR MI
48180-4696
US

IV. Provider business mailing address

22970 NORTHLINE RD STE 100
TAYLOR MI
48180-4696
US

V. Phone/Fax

Practice location:
  • Phone: 734-287-6585
  • Fax: 734-287-6647
Mailing address:
  • Phone: 734-287-6585
  • Fax: 734-287-6647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number StateMI

VIII. Authorized Official

Name: BARRY L. BLANTON
Title or Position: VICE PRESIDENT
Credential:
Phone: 781-699-9000