Provider Demographics
NPI:1770575706
Name:AMERICAN DIABETIC SUPPLY, INC.
Entity type:Organization
Organization Name:AMERICAN DIABETIC SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-449-8055
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48376-0602
Mailing Address - Country:US
Mailing Address - Phone:248-449-8055
Mailing Address - Fax:888-449-8057
Practice Address - Street 1:28317 BECK RD
Practice Address - Street 2:E-18
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-4729
Practice Address - Country:US
Practice Address - Phone:248-449-8055
Practice Address - Fax:888-449-8057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2022-07-21
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
OH2750287Medicaid
MI54-0-F3-1442-0OtherBCBSMI PROVIDER ID
MI4979367Medicaid
OH2750287Medicaid