Healthcare Provider Details

I. General information

NPI: 1003796715
Provider Name (Legal Business Name): MOTOR CITY LIFT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28263 HOOVER RD
WARREN MI
48093-5436
US

IV. Provider business mailing address

28263 HOOVER RD
WARREN MI
48093-5436
US

V. Phone/Fax

Practice location:
  • Phone: 313-434-5505
  • Fax:
Mailing address:
  • Phone: 313-434-5505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY WALDBURG
Title or Position: CEO
Credential:
Phone: 313-434-5505