| Organization Name: | MICHIGAN MEDICAL SUPPLY INC |
| NPI Number: | 1053391714 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBIN L MENCHEN (CHIEF ADMINISTRTION OFFICER) |
| Mailing Address: | 8113 Belmont Ave Ne Suite A Belmont |
| State: | MI US |
| Postal Code: | 493068823 |
| Phone Number: | 6168638908 |
| Fax Number: | 6168639105 |
| NPI Enumeration Date: | 01/19/2006 |
| NPI Last Update Date: | 08/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |