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General NPI Number Information
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NPI Number | 1336161272
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Entity Type | Organization
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Legal Business Name | ATLANTIS MEDICAL EQUIPMENTS & SUPPLY COMPANY, LLC
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 02/18/2008
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Provider Practice Location Address
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Address Line | 30900 FORD RD SUITE F
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City | GARDEN CITY
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State | MI
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Zip | 48135-1892
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Country | US
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Telephone | 734-266-0575
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Fax | 734-266-0971
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Provider Business Mailing Address
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Address Line | 30900 FORD RD SUITE F
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City | GARDEN CITY
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State | MI
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Zip | 48135-1892
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Country | US
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Telephone | 734-266-0575
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Fax | 734-266-0971
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Authorized Official
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Title or Position | PRESIDENT /CEO
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Name | DR. CHINWENDU IKE MBANUGO
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Credential | PH.D.
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Telephone | 734-266-0575
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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 | 4862749
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License Number State | MI
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