MEDICARE: JEFFREY PAUL CATES

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	171WH0202X	Home Modifications Contractor	2102185764	MI
2	332B00000X	Durable Medical Equipment & Medical Supplies	2102185764	MI
3	332BC3200X	Customized Equipment (DME)	2102185764	MI
4	171W00000X	Contractor	2102185764	MI

General Provider Information

NPI Number	:	1659934669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY PAUL CATES

Provider Business Mailing Address
First Line	:	PO BOX 1379
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48068-1379
Country	:	US
Telephone Number	:	248-246-1669
Fax Number	:

Provider Business Practice Location Address
First Line	:	826 W 11 MILE RD
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-3102
Country	:	US
Telephone Number	:	248-246-1669
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2019
Last Update Date	:	04/10/2020

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