Provider Demographics
NPI:1093110264
Name:MOBILE SURGICAL EQUIPMENT OF MICHIGAN LLC
Entity Type:Organization
Organization Name:MOBILE SURGICAL EQUIPMENT OF MICHIGAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:GANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-756-5760
Mailing Address - Street 1:50749 CHESAPEAKE DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-2551
Mailing Address - Country:US
Mailing Address - Phone:773-756-5760
Mailing Address - Fax:773-714-1229
Practice Address - Street 1:50749 CHESAPEAKE DR
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-2551
Practice Address - Country:US
Practice Address - Phone:773-756-5760
Practice Address - Fax:773-714-1229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies