Healthcare Provider Details

I. General information

NPI: 1750608477
Provider Name (Legal Business Name): PROS-TECH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13850 E 12 MILE RD SUITE 2B
WARREN MI
48088-3730
US

IV. Provider business mailing address

1717 STEPHENSON HWY
TROY MI
48083-2149
US

V. Phone/Fax

Practice location:
  • Phone: 586-541-1040
  • Fax: 586-552-8310
Mailing address:
  • Phone: 248-680-2800
  • Fax: 248-680-2804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. KEITH E GIRARDOT
Title or Position: PRESIDENT
Credential: C.P.
Phone: 248-680-2800