Provider Demographics
NPI:1952861247
Name:DEGROFF ORTHOPEDIC SUPPLIES INC.
Entity Type:Organization
Organization Name:DEGROFF ORTHOPEDIC SUPPLIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGROFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-330-7728
Mailing Address - Street 1:7688 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1409
Mailing Address - Country:US
Mailing Address - Phone:248-303-3741
Mailing Address - Fax:248-559-7710
Practice Address - Street 1:7688 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1409
Practice Address - Country:US
Practice Address - Phone:248-303-3741
Practice Address - Fax:248-559-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies