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Organization
OWNERS ON CALL
Active
Organization
OWNERS ON CALL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLIE BOTHUELL IV (CEO)
(248) 979-1464
Entity
Organization
Contact information
Practice address
1344 NICOLET PL, DETROIT, MI 48207-2838
(248) 979-1464
Mailing address
1344 NICOLET PL, DETROIT, MI 48207-2838
(248) 979-1464
Taxonomy
Speciality
Code
Description
License number
State
343800000X
Secured Medical Transport (VAN)
—
NULL
347C00000X
Private Vehicle
Primary
—
NULL
Other
Enumeration date
04/29/2012
Last updated
04/29/2012
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