Provider Demographics
NPI:1174041909
Name:EXECUTIVE EDGE INTERNATIONAL, INC.
Entity Type:Organization
Organization Name:EXECUTIVE EDGE INTERNATIONAL, INC.
Other - Org Name:FIVE ELEMENT ACUPUNCTURE OF MICHIGAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GIGI
Authorized Official - Middle Name:BADILA
Authorized Official - Last Name:CRISTACHE
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM, RAC, MAC
Authorized Official - Phone:248-790-4061
Mailing Address - Street 1:30426 KNIGHTON DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1657
Mailing Address - Country:US
Mailing Address - Phone:248-790-4061
Mailing Address - Fax:
Practice Address - Street 1:32905 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3342
Practice Address - Country:US
Practice Address - Phone:248-790-4061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-31
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty