Provider Demographics
NPI:1770837296
Name:MICHIGAN HOME EXTERIORS
Entity Type:Organization
Organization Name:MICHIGAN HOME EXTERIORS
Other - Org Name:MICHIGAN HOME INTERIORS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:RADLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-789-2284
Mailing Address - Street 1:11444 KALTZ AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-1867
Mailing Address - Country:US
Mailing Address - Phone:586-256-5393
Mailing Address - Fax:
Practice Address - Street 1:11444 KALTZ AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089
Practice Address - Country:US
Practice Address - Phone:586-256-5393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2101170519332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies