Provider Demographics
NPI:1750387338
Name:DIABETIC MANAGEMENT EQUIPMENT
Entity type:Organization
Organization Name:DIABETIC MANAGEMENT EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-634-6709
Mailing Address - Street 1:10299 GRAND RIVER RD
Mailing Address - Street 2:STE M
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-9558
Mailing Address - Country:US
Mailing Address - Phone:800-634-6709
Mailing Address - Fax:
Practice Address - Street 1:10299 GRAND RIVER RD
Practice Address - Street 2:STE M
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-9558
Practice Address - Country:US
Practice Address - Phone:800-634-6709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0181790001Medicare NSC