MEDICARE: INFUSAL DIRECT, 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	173000000X	Legal Medicine

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OP53590	OTHER	MI	MEDICARE PTAN

General Provider Information

NPI Number	:	1659569796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFUSAL DIRECT, INC.

Provider Business Mailing Address
First Line	:	8315 GRAND RIVER AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48204-2231
Country	:	US
Telephone Number	:	313-361-1030
Fax Number	:

Provider Business Practice Location Address
First Line	:	8315 GRAND RIVER AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48204-2231
Country	:	US
Telephone Number	:	313-361-1030
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YIPSIS OROZCO-RUIZ
Credential	:
Telephone Number	:	313-361-1030

Provider Enumeration Date	:	10/12/2007
Last Update Date	:	05/08/2009

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Directions to “INFUSAL DIRECT, INC. ” Practice Location

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