Healthcare Provider Details

I. General information

NPI: 1770575706
Provider Name (Legal Business Name): AMERICAN DIABETIC SUPPLY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28317 BECK RD E-18
WIXOM MI
48393-4729
US

IV. Provider business mailing address

PO BOX 602
NOVI MI
48376-0602
US

V. Phone/Fax

Practice location:
  • Phone: 248-449-8055
  • Fax: 888-449-8057
Mailing address:
  • Phone: 248-449-8055
  • Fax: 888-449-8057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. WILLIAM L CARLIN
Title or Position: PRESIDENT
Credential:
Phone: 248-449-8055