Provider Demographics
NPI:1578627634
Name:PROCARE MEDICAL INC.
Entity Type:Organization
Organization Name:PROCARE MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEENA
Authorized Official - Middle Name:R
Authorized Official - Last Name:NAIDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-955-6088
Mailing Address - Street 1:18708 TELEGRAPH RD
Mailing Address - Street 2:STE C1
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48174-9595
Mailing Address - Country:US
Mailing Address - Phone:734-955-6088
Mailing Address - Fax:734-942-7662
Practice Address - Street 1:18708 TELEGRAPH RD
Practice Address - Street 2:STE C1
Practice Address - City:BROWNSTOWN
Practice Address - State:MI
Practice Address - Zip Code:48174-9595
Practice Address - Country:US
Practice Address - Phone:734-955-6088
Practice Address - Fax:734-942-7662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3974610001Medicare NSC