Healthcare Provider Details

I. General information

NPI: 1386988707
Provider Name (Legal Business Name): HEALTH NET CONNECT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2012
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50496 PONTIAC TRL SUITE 700
WIXOM MI
48393-2088
US

IV. Provider business mailing address

50496 PONTIAC TRL SUITE 700
WIXOM MI
48393-2088
US

V. Phone/Fax

Practice location:
  • Phone: 248-896-6240
  • Fax: 248-960-8082
Mailing address:
  • Phone: 248-896-6240
  • Fax: 248-960-8082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. CORKY J DAVIS
Title or Position: COO
Credential:
Phone: 248-896-6240