Provider Demographics
NPI:1639423049
Name:MIDLAND FAMILY MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:MIDLAND FAMILY MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER PLLC
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:STERNBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:989-631-0200
Mailing Address - Street 1:2924 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4443
Mailing Address - Country:US
Mailing Address - Phone:989-631-0200
Mailing Address - Fax:989-631-2210
Practice Address - Street 1:2924 MANOR DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4443
Practice Address - Country:US
Practice Address - Phone:989-631-0200
Practice Address - Fax:989-631-2210
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDLAND FAMILY FOOTCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILS001623335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU20397Medicare UPIN