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Organization
MDL VENTURES OF WEST BLOOMFIELD ACTIVERX
Active
Organization
MDL VENTURES OF WEST BLOOMFIELD ACTIVERX
Active
Other names
ActiveRx of West Bloomfield
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK DAVID LINES (OWNER)
(248) 932-0111
Entity
Organization
Contact information
Practice address
6018 W MAPLE RD, SUITE 850, WEST BLOOMFIELD, MI 48322-4404
(248) 932-0111
(248) 932-0110
Mailing address
6018 W MAPLE RD, SUITE 850, WEST BLOOMFIELD, MI 48322-4404
(248) 932-0111
(248) 932-0110
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
12/14/2012
Last updated
12/24/2012
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