| NPI | 1588780456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE BRADFORD-HENRY Director 248-565-4024 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: MI 001148) |
| 174400000X Specialist (Licence: MI 001148) | |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MI 001148) | |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2008-02-15 |