Provider Demographics
NPI:1558456301
Name:MITCHELL HOME MEDICAL, INC.
Entity Type:Organization
Organization Name:MITCHELL HOME MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:W
Authorized Official - Last Name:MICHALUK
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:734-572-0203
Mailing Address - Street 1:4811 CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9609
Mailing Address - Country:US
Mailing Address - Phone:734-572-0203
Mailing Address - Fax:734-572-0281
Practice Address - Street 1:455 E GRAND RIVER AVE
Practice Address - Street 2:STE 206
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1551
Practice Address - Country:US
Practice Address - Phone:810-229-9200
Practice Address - Fax:810-229-9260
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANN ARBOR WELDING SUPPLY CO., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-04
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3944540002Medicare NSC