Healthcare Provider Details

I. General information

NPI: 1558320812
Provider Name (Legal Business Name): DIRECT MEDICAL EQUIPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52502 GRAND RIVER AVE
WIXOM MI
48393-2318
US

IV. Provider business mailing address

52502 GRAND RIVER AVE
WIXOM MI
48393-2318
US

V. Phone/Fax

Practice location:
  • Phone: 248-491-0276
  • Fax: 248-491-0279
Mailing address:
  • Phone: 248-491-0276
  • Fax: 248-491-0279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. ANTHONY WILLIAM POLLICELLA
Title or Position: PRESIDENT
Credential:
Phone: 734-451-1414