Healthcare Provider Details

I. General information

NPI: 1629037692
Provider Name (Legal Business Name): ADAPTIVE MEDIQUIP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64007 VAN DYKE RD STE. 2
WASHINGTON MI
48095-2581
US

IV. Provider business mailing address

64007 VAN DYKE RD STE. 2
WASHINGTON MI
48095-2581
US

V. Phone/Fax

Practice location:
  • Phone: 586-477-4535
  • Fax: 586-477-4578
Mailing address:
  • Phone: 586-477-4535
  • Fax: 586-477-4578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL FRAUTTEN
Title or Position: OWNER
Credential:
Phone: 586-477-4535