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General NPI Number Information
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NPI Number | 1659716744
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Entity Type | Organization
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Legal Business Name | CEVIAN HEALTH DISTRIBUTORS, LLC
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Dates
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Enumeration Date | 05/03/2013
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Last Update Date | 11/06/2014
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Provider Practice Location Address
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Address Line | 20615 FENKELL ST UNIT 23851
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City | DETROIT
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State | MI
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Zip | 48223-3745
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Country | US
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Telephone | 248-429-7381
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Fax |
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Provider Business Mailing Address
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Address Line | 20615 FENKELL ST UNIT 23851
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City | DETROIT
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State | MI
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Zip | 48223-3745
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SEAN SLADE
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Credential |
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Telephone | 248-429-7381
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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 | 5306004024
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License Number State | MI
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