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General NPI Number Information
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NPI Number | 1932453594
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Entity Type | Organization
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Legal Business Name | ANEW LIFE PROSTHETICS AND ORTHOTICS LLC
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 6438 WOODWARD AVE
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City | DETROIT
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State | MI
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Zip | 48202-3216
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Country | US
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Telephone | 313-870-9610
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Fax |
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Provider Business Mailing Address
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Address Line | 6438 WOODWARD AVE
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City | DETROIT
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State | MI
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Zip | 48202-3216
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Country | US
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Telephone | 313-870-9610
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MR. CHRISTOPHER TOD CASTEEL
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Credential | BOCO
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Telephone | 313-870-9610
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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 | MI
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