MEDICARE: BIO MEDICAL APPLICATIONS OF MICHIGAN 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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1346400629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIO MEDICAL APPLICATIONS OF MICHIGAN INC

Provider Business Mailing Address
First Line	:	5414 W ROLLING HILLS DR
Second Line	:
City	:	BRIDGEPORT
State	:	MI
Zip	:	48722-9668
Country	:	US
Telephone Number	:	810-733-2283
Fax Number	:	810-733-7725

Provider Business Practice Location Address
First Line	:	5414 W ROLLING HILLS DR
Second Line	:
City	:	BRIDGEPORT
State	:	MI
Zip	:	48722-9668
Country	:	US
Telephone Number	:	810-733-2283
Fax Number	:	810-733-7725

Authorized Official
Title or Position	:	TREASURER
Name	:	MARK FAWCETT
Credential	:
Telephone Number	:	781-699-9000

Provider Enumeration Date	:	06/11/2008
Last Update Date	:	09/05/2012

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