Provider Demographics
NPI:1972671477
Name:AMERIMED DIABETIC SUPPLY COMPANY
Entity Type:Organization
Organization Name:AMERIMED DIABETIC SUPPLY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARETT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-342-9927
Mailing Address - Street 1:9555 COMMERCE RD
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4165
Mailing Address - Country:US
Mailing Address - Phone:248-342-9927
Mailing Address - Fax:248-360-3808
Practice Address - Street 1:9555 COMMERCE RD
Practice Address - Street 2:SUITE 2B
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-4165
Practice Address - Country:US
Practice Address - Phone:248-342-9927
Practice Address - Fax:248-360-3808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5444750001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER