Provider Demographics
NPI:1417323635
Name:CHILDS, MICHAEL A
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:CHILDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3833 BURNS
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-1272
Mailing Address - Country:US
Mailing Address - Phone:313-466-3220
Mailing Address - Fax:313-466-3220
Practice Address - Street 1:3833 BURNS
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-1272
Practice Address - Country:US
Practice Address - Phone:313-466-3220
Practice Address - Fax:313-466-3220
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL10497343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)