MEDICARE: WISE WELL SUPPLIES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1063387686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISE WELL SUPPLIES INC

Provider Business Mailing Address
First Line	:	418 N MAIN ST FL 2
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-1813
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	418 N MAIN ST FL 2
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-1813
Country	:	US
Telephone Number	:	313-465-4301
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	AMANUDDIN MOHAMMAD
Credential	:
Telephone Number	:	313-465-4301

Provider Enumeration Date	:	10/06/2025
Last Update Date	:	06/02/2026

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Directions to “WISE WELL SUPPLIES INC ” Practice Location

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