MEDICARE: DIRECT MEDICAL EQUIPMENT

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	332BC3200X	Customized Equipment (DME)	MI
2	332BX2000X	Oxygen Equipment & Supplies (DME)	MI
3	332B00000X	Durable Medical Equipment & Medical Supplies	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	540H220960	OTHER	MI	BLUE CROSS OF MICHIGAN
2	145537	OTHER	MI	GREAT LAKES HMO
3	30242	OTHER	MI	HEALTH PLAN OF MICHIGAN
4	11389	OTHER	MI	CAPE HMO
5	4491239	OTHER	MI	MOLINA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	540F340020	OTHER	MI	BLUE CROSS OF MICHIGAN
8	136043	OTHER	MI	CARE CHOICES
9	DM15364	OTHER	MI	MCARE

General Provider Information

NPI Number	:	1558320812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIRECT MEDICAL EQUIPMENT

Provider Business Mailing Address
First Line	:	52502 GRAND RIVER AVE
Second Line	:
City	:	WIXOM
State	:	MI
Zip	:	48393-2318
Country	:	US
Telephone Number	:	248-491-0276
Fax Number	:	248-491-0279

Provider Business Practice Location Address
First Line	:	52502 GRAND RIVER AVE
Second Line	:
City	:	WIXOM
State	:	MI
Zip	:	48393-2318
Country	:	US
Telephone Number	:	248-491-0276
Fax Number	:	248-491-0279

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ANTHONY WILLIAM POLLICELLA
Credential	:
Telephone Number	:	734-451-1414

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	07/21/2022

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1427045483 — DR. CHITRA ASHER M.D.
Practice Location Address:

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1982691846 — DR. RITA KHANEJA-SHARROW D.O.
Practice Location Address:

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1487613899 — SHAWN WILLIAM GRANT MS PT
Practice Location Address:

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Directions to “DIRECT MEDICAL EQUIPMENT ” Practice Location

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