Healthcare Provider Details

I. General information

NPI: 1548701014
Provider Name (Legal Business Name): MI MED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2017
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7688 HIGHLAND RD
WATERFORD MI
48327-1409
US

IV. Provider business mailing address

7688 HIGHLAND RD
WATERFORD MI
48327-1409
US

V. Phone/Fax

Practice location:
  • Phone: 248-648-0675
  • Fax: 248-599-7710
Mailing address:
  • Phone: 248-648-0675
  • Fax: 248-599-7710

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 Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER DEGROFF
Title or Position: OWNER/DIRECTOR OF OPERATIONS
Credential: COF
Phone: 248-648-0675