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General NPI Number Information
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NPI Number | 1265328876
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Entity Type | Organization
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Legal Business Name | ATHENA MEDICAL SUPPLIES, INC
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Dates
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Enumeration Date | 06/18/2025
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 8424 E 12 MILE RD STE B4-1
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City | WARREN
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State | MI
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Zip | 48093-2700
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Country | US
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Telephone | 248-399-6569
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Fax | 248-399-6749
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Provider Business Mailing Address
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Address Line | 8424 E 12 MILE RD STE B4-1
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City | WARREN
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State | MI
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Zip | 48093-2700
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Country | US
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Telephone | 248-399-6569
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Fax | 248-399-6749
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DEEPTI KALYANKAR
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Credential |
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Telephone | 248-399-4223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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