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General NPI Number Information
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NPI Number | 1356441687
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Entity Type | Organization
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Legal Business Name | MICHIGAN DIABETES SUPPLIES LLC
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4038 GRANGE HALL RD
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City | HOLLY
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State | MI
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Zip | 48442-1160
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Country | US
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Telephone | 800-321-5290
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Fax | 248-634-2040
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Provider Business Mailing Address
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Address Line | 4038 GRANGE HALL RD
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City | HOLLY
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State | MI
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Zip | 48442-1160
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Country | US
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Telephone | 800-321-5290
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Fax | 248-634-2040
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Authorized Official
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Title or Position | OWNER
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Name | MR. EVERARD LESTER DOMINY
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Credential |
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Telephone | 800-321-5290
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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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