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General NPI Number Information
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NPI Number | 1821234998
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Entity Type | Organization
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Legal Business Name | PROUD MARY BRAS
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Dates
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Enumeration Date | 12/19/2008
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Last Update Date | 12/19/2008
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Provider Practice Location Address
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Address Line | 6305 WALL ST
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City | STERLING HEIGHTS
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State | MI
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Zip | 48312-1078
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Country | US
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Telephone | 877-627-9272
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Fax |
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Provider Business Mailing Address
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Address Line | 6305 WALL ST
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City | STERLING HEIGHTS
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State | MI
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Zip | 48312-1078
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Country | US
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Telephone | 877-627-9272
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Fax |
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Authorized Official
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Title or Position | PROSTHETIC BUSINESS UNIT MANAGER
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Name | MRS. TRACY MARIE BUSH
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Credential |
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Telephone | 586-264-2283
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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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