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General NPI Number Information
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NPI Number | 1912301680
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Entity Type | Organization
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Legal Business Name | PATRIOTS SUPPLY INC.
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Dates
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Enumeration Date | 10/09/2014
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Last Update Date | 10/09/2014
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Provider Practice Location Address
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Address Line | 15760 19 MILE RD SUITE E
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-6319
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Country | US
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Telephone | 586-489-1193
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Fax | 586-416-2580
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Provider Business Mailing Address
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Address Line | 15760 19 MILE RD SUITE E
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-6319
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Country | US
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Telephone | 586-489-1193
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Fax | 586-416-2580
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Authorized Official
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Title or Position | CEO
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Name | MR. ROBERT WARREN RUDOWSKI II
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Credential | PHD
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Telephone | 586-489-1193
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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 |
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License Number State | MI
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