Provider Demographics
NPI:1841871761
Name:MAGIC MEDICAL WHOLESALE INC.
Entity type:Organization
Organization Name:MAGIC MEDICAL WHOLESALE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN VLIET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-207-0560
Mailing Address - Street 1:43311 JOY RD # 615
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2075
Mailing Address - Country:US
Mailing Address - Phone:734-207-0560
Mailing Address - Fax:734-207-0746
Practice Address - Street 1:44772 KIRK CT
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1717
Practice Address - Country:US
Practice Address - Phone:734-207-0560
Practice Address - Fax:734-207-0746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies