Provider Demographics
NPI:1639315112
Name:MIOTECH ORTHOPEDIC SALES, LLC
Entity Type:Organization
Organization Name:MIOTECH ORTHOPEDIC SALES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ZISHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-347-0220
Mailing Address - Street 1:4125 OKEMOS RD
Mailing Address - Street 2:SUITE 22
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2819
Mailing Address - Country:US
Mailing Address - Phone:517-347-0220
Mailing Address - Fax:517-347-0221
Practice Address - Street 1:4125 OKEMOS RD
Practice Address - Street 2:SUITE 22
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2819
Practice Address - Country:US
Practice Address - Phone:517-347-0220
Practice Address - Fax:517-347-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies