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General NPI Number Information
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NPI Number | 1548701014
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Entity Type | Organization
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Legal Business Name | MI MED INC
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Dates
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Enumeration Date | 03/16/2017
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Last Update Date | 03/16/2017
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Provider Practice Location Address
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Address Line | 7688 HIGHLAND RD
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City | WATERFORD
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State | MI
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Zip | 48327-1409
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Country | US
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Telephone | 248-648-0675
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Fax | 248-599-7710
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Provider Business Mailing Address
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Address Line | 7688 HIGHLAND RD
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City | WATERFORD
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State | MI
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Zip | 48327-1409
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Country | US
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Telephone | 248-648-0675
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Fax | 248-599-7710
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Authorized Official
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Title or Position | OWNER/DIRECTOR OF OPERATIONS
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Name | CHRISTOPHER DEGROFF
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Credential | COF
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Telephone | 248-648-0675
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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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Taxonomy #2
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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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