Organization
DIRECT MEDICAL EQUIPMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTHONY WILLIAM POLLICELLA (PRESIDENT)
(734) 451-1414
Entity
Organization
Contact information
Practice address
52502 GRAND RIVER AVE, WIXOM, MI 48393-2318
(248) 491-0276
(248) 491-0279
Mailing address
52502 GRAND RIVER AVE, WIXOM, MI 48393-2318
(248) 491-0276
(248) 491-0279
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
MI
332BC3200X
Customized Equipment (DME)
—
MI
332BX2000X
Oxygen Equipment & Supplies (DME)
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11389
CAPE HMO
MI
01
—
136043
CARE CHOICES
MI
01
—
145537
GREAT LAKES HMO
MI
01
—
30242
HEALTH PLAN OF MICHIGAN
MI
01
—
4491239
MOLINA
MI
05
—
4491239
—
MI
01
—
540F340020
BLUE CROSS OF MICHIGAN
MI
01
—
540H220960
BLUE CROSS OF MICHIGAN
MI
01
—
DM15364
MCARE
MI
Enumeration date
03/23/2006
Last updated
07/21/2022
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