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Organization
MIDWEST BRACE AND LIMB INC
Active
Organization
MIDWEST BRACE AND LIMB INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS WAYNE MULLIN (OWNER/PRESIDENT)
(765) 447-6323
Entity
Organization
Contact information
Practice address
3802 AMELIA AVE, SUITE B, LAFAYETTE, IN 47905-5772
(765) 447-6323
(765) 446-1575
Mailing address
3802 AMELIA AVE, SUITE B, LAFAYETTE, IN 47905-5772
(765) 447-6323
(765) 446-1575
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
C15097
IN
Other
Enumeration date
07/07/2005
Last updated
05/24/2010
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