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General NPI Number Information
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NPI Number | 1457867574
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Entity Type | Organization
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Legal Business Name | PHYSICIANS TECHNOLOGY, LLC
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Dates
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Enumeration Date | 12/27/2017
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Last Update Date | 12/27/2017
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Provider Practice Location Address
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Address Line | 23 E FRONT ST STE 200
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City | MONROE
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State | MI
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Zip | 48161-2210
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Country | US
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Telephone | 734-241-5060
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Fax |
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Provider Business Mailing Address
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Address Line | 23 E FRONT ST STE 200
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City | MONROE
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State | MI
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Zip | 48161-2210
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Country | US
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Telephone | 734-241-5060
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. KEN GERARD FIEMA
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Credential | CPA
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Telephone | 734-241-5060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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