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General NPI Number Information
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NPI Number | 1548010507
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Entity Type | Organization
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Legal Business Name | BELLA ME LUXE
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Dates
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Enumeration Date | 03/25/2024
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 16000 W 9 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4808
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Country | US
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Telephone | 248-678-5716
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Fax |
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Provider Business Mailing Address
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Address Line | 22466 TWYCKINGHAM WAY
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City | SOUTHFIELD
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State | MI
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Zip | 48034-2138
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Country | US
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Telephone | 248-678-5716
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Fax |
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Authorized Official
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Title or Position | ACCOUNT MANAGER
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Name | DARSHENA SHANIKA BRYANT
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Credential |
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Telephone | 248-678-5716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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