Provider Demographics
NPI:1750459277
Name:HAMTRAMCK DURABLE MEDICAL EQUIPMENT
Entity type:Organization
Organization Name:HAMTRAMCK DURABLE MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAMIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-365-9802
Mailing Address - Street 1:11653 JOSEPH CAMPAU ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3839
Mailing Address - Country:US
Mailing Address - Phone:313-365-9802
Mailing Address - Fax:313-365-9804
Practice Address - Street 1:11653 JOSEPH CAMPAU ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3839
Practice Address - Country:US
Practice Address - Phone:313-365-9802
Practice Address - Fax:313-365-9804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540H225670OtherBLUE CROSS BLUE SHEILD
MS5418320001Medicare NSC