Organization
MIGUN W B L L C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK RUSSELL (OWNER)
(248) 921-6659
Entity
Organization
Contact information
Practice address
6718 ORCHARD LAKE RD, WEST BLOOMFIELD, MI 48322-3491
(248) 539-9955
Mailing address
6718 ORCHARD LAKE RD, WEST BLOOMFIELD, MI 48322-3491
(248) 539-9955
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
02/20/2007
Last updated
08/22/2020
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