Provider Demographics
NPI:1649786021
Name:TRAVERSE CITY MEDICAL LLC
Entity type:Organization
Organization Name:TRAVERSE CITY MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MOIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAHID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-204-4714
Mailing Address - Street 1:801 S GARFIELD AVE # 218
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3429
Mailing Address - Country:US
Mailing Address - Phone:248-204-4714
Mailing Address - Fax:
Practice Address - Street 1:801 S GARFIELD AVE
Practice Address - Street 2:# 218
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3429
Practice Address - Country:US
Practice Address - Phone:248-204-4714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies