Provider Demographics
NPI:1851626238
Name:LIFETIME MOBILITY PRODUCTS
Entity Type:Organization
Organization Name:LIFETIME MOBILITY PRODUCTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:FERDINAND
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-636-0751
Mailing Address - Street 1:4606 TAMIE AVE
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-2136
Mailing Address - Country:US
Mailing Address - Phone:612-636-0751
Mailing Address - Fax:
Practice Address - Street 1:W7652 2090TH AVE
Practice Address - Street 2:
Practice Address - City:HAGER CITY
Practice Address - State:WI
Practice Address - Zip Code:54014
Practice Address - Country:US
Practice Address - Phone:612-636-0751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFETIME CARE AT HOME LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies