Provider Demographics
NPI:1740727197
Name:INDEPENDENT FEEDING DEVICE, LLC
Entity type:Organization
Organization Name:INDEPENDENT FEEDING DEVICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DEKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-506-9688
Mailing Address - Street 1:329 WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1063
Mailing Address - Country:US
Mailing Address - Phone:313-506-9688
Mailing Address - Fax:
Practice Address - Street 1:329 WILSHIRE DR
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-1063
Practice Address - Country:US
Practice Address - Phone:313-506-9688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies