Provider Demographics
NPI:1407867831
Name:ULTRALIGHT PROSTHETICS, INC
Entity Type:Organization
Organization Name:ULTRALIGHT PROSTHETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:GIACINTO
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:313-538-8500
Mailing Address - Street 1:24781 5 MILE RD
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-3632
Mailing Address - Country:US
Mailing Address - Phone:313-538-8500
Mailing Address - Fax:313-538-8501
Practice Address - Street 1:24781 5 MILE RD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3632
Practice Address - Country:US
Practice Address - Phone:313-538-8500
Practice Address - Fax:313-538-8501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0227260001Medicare NSC