MEDICARE: AMERICAN DIABETIC SUPPLY, 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	332B00000X	Durable Medical Equipment & Medical Supplies		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
2	54-0-F3-1442-0	OTHER	MI	BCBSMI PROVIDER ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770575706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN DIABETIC SUPPLY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 602
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48376-0602
Country	:	US
Telephone Number	:	248-449-8055
Fax Number	:	888-449-8057

Provider Business Practice Location Address
First Line	:	28317 BECK RD
Second Line	:	E-18
City	:	WIXOM
State	:	MI
Zip	:	48393-4729
Country	:	US
Telephone Number	:	248-449-8055
Fax Number	:	888-449-8057

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. WILLIAM L CARLIN
Credential	:
Telephone Number	:	248-449-8055

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	07/21/2022

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