MEDICARE: MIDMICHIGAN INFUSION CARE

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	251F00000X	Home Infusion Agency	5301007845	MI

General Provider Information

NPI Number	:	1073515664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDMICHIGAN INFUSION CARE

Provider Business Mailing Address
First Line	:	4568 M 30
Second Line	:
City	:	BEAVERTON
State	:	MI
Zip	:	48612-8548
Country	:	US
Telephone Number	:	989-435-2631
Fax Number	:	989-435-2801

Provider Business Practice Location Address
First Line	:	4568 M 30
Second Line	:
City	:	BEAVERTON
State	:	MI
Zip	:	48612-8548
Country	:	US
Telephone Number	:	989-435-2631
Fax Number	:	989-435-2801

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. THOMAS TOMASKI
Credential	:	RPH
Telephone Number	:	800-732-4879

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	08/22/2020

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