Organization Name: | DIRECT MEDICAL PLLC |
NPI Number: | 1053672923 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SUZANNE OSANTOWSKI (OWNER/NURSE) |
Mailing Address: | 22150 Greenfield Rd Suite 203 Oak Park |
State: | MI US |
Postal Code: | 482372535 |
Phone Number: | 2482460533 |
Fax Number: | |
NPI Enumeration Date: | 06/06/2012 |
NPI Last Update Date: | 06/06/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |