Organization
MACOMB MEDICAL SUPPLY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES JOHN NOVAK JR. (PRESIDENT)
(586) 790-5867
Entity
Organization
Contact information
Practice address
36562 MORAVIAN DR, CLINTON TOWNSHIP, MI 48035-1202
(586) 790-5867
(586) 790-5916
Mailing address
36562 MORAVIAN DR, CLINTON TOWNSHIP, MI 48035-1202
(586) 790-5867
(586) 790-5916
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3271301
—
MI
01
—
540EO04450
BCBS
MI
Enumeration date
12/22/2005
Last updated
08/22/2020
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