Provider Demographics
NPI:1053672923
Name:DIRECT MEDICAL PLLC
Entity Type:Organization
Organization Name:DIRECT MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSANTOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:248-246-0533
Mailing Address - Street 1:22150 GREENFIELD RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2535
Mailing Address - Country:US
Mailing Address - Phone:248-246-0533
Mailing Address - Fax:
Practice Address - Street 1:22150 GREENFIELD RD
Practice Address - Street 2:SUITE 203
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2535
Practice Address - Country:US
Practice Address - Phone:248-246-0533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty