Provider Demographics
NPI:1437478088
Name:MOBILE PROSTHETICS OF MICHIGAN CORP
Entity Type:Organization
Organization Name:MOBILE PROSTHETICS OF MICHIGAN CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESTIDENT/CERT. PROSTHESIS
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:G
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PROSTHESIS
Authorized Official - Phone:989-875-7000
Mailing Address - Street 1:1326 E CENTER ST STE 2
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:MI
Mailing Address - Zip Code:48847-1619
Mailing Address - Country:US
Mailing Address - Phone:989-875-7000
Mailing Address - Fax:989-875-7007
Practice Address - Street 1:1326 E CENTER ST STE 2
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:MI
Practice Address - Zip Code:48847-1619
Practice Address - Country:US
Practice Address - Phone:989-875-7000
Practice Address - Fax:989-875-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-21
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6370760001Medicare NSC