Provider Demographics
NPI:1750316220
Name:THE MEDICAL TEAM, INC
Entity Type:Organization
Organization Name:THE MEDICAL TEAM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRISARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-390-2300
Mailing Address - Street 1:17197 N LAUREL PARK DR
Mailing Address - Street 2:SUITE 555
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2680
Mailing Address - Country:US
Mailing Address - Phone:734-779-9700
Mailing Address - Fax:734-779-9799
Practice Address - Street 1:17197 N LAUREL PARK DR
Practice Address - Street 2:SUITE 555
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2680
Practice Address - Country:US
Practice Address - Phone:734-779-9700
Practice Address - Fax:734-779-9799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI15 1490111Medicaid