Provider Demographics
NPI:1326345109
Name:INTEGRA HEALTHCARE EQUIPMENT OF MICHIGAN, LLC
Entity Type:Organization
Organization Name:INTEGRA HEALTHCARE EQUIPMENT OF MICHIGAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EITAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHECHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-917-7200
Mailing Address - Street 1:747 N CHURCH RD
Mailing Address - Street 2:SUITE G7
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-1420
Mailing Address - Country:US
Mailing Address - Phone:847-917-7200
Mailing Address - Fax:
Practice Address - Street 1:2625 HILTON RD
Practice Address - Street 2:UNIT 2
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-3020
Practice Address - Country:US
Practice Address - Phone:888-828-7729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1326345109Medicaid
MI1326345109Medicaid