Provider Demographics
NPI:1386672004
Name:LIFE EXTENSION MEDICAL EQUIPMENT LLC
Entity Type:Organization
Organization Name:LIFE EXTENSION MEDICAL EQUIPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AZHAR
Authorized Official - Middle Name:UL
Authorized Official - Last Name:ISLAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-280-3820
Mailing Address - Street 1:11 W 14 MILE RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-3104
Mailing Address - Country:US
Mailing Address - Phone:248-280-3820
Mailing Address - Fax:248-280-3823
Practice Address - Street 1:29350 SOUTHFIELD RD
Practice Address - Street 2:SUITE 115
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2053
Practice Address - Country:US
Practice Address - Phone:248-395-1511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIB332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies