MEDICARE: MOBILITY PLUS SPECIALIST

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	332BC3200X	Customized Equipment (DME)		MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619196078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILITY PLUS SPECIALIST

Provider Business Mailing Address
First Line	:	20114 LIVERNOIS AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221-1346
Country	:	US
Telephone Number	:	313-218-1224
Fax Number	:

Provider Business Practice Location Address
First Line	:	20114 LIVERNOIS AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221-1346
Country	:	US
Telephone Number	:	313-218-1224
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTINE M MORGAN
Credential	:
Telephone Number	:	313-218-1224

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	03/31/2008

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