| NPI | 1245620350 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY T FISHMAN Member 248-882-2070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MI 2901011555) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901011555) |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: MI 2901011555) | |
| Enumeration Date | 2015-01-27 |
| Last Update Date | 2016-09-09 |