Organization
PROFESSIONAL HOME CARE DEARBORN OXYGEN THERAPY CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN G KOLFAGE (PRESIDENT)
(313) 277-2160
Entity
Organization
Contact information
Practice address
24706 MICHIGAN AVE, DEARBORN, MI 48124-1750
(313) 277-2160
(313) 277-3079
Mailing address
24706 MICHIGAN AVE, DEARBORN, MI 48124-1750
(313) 277-2160
(313) 277-3079
Taxonomy
Speciality
Code
Description
License number
State
332100000X
Department of Veterans Affairs (VA) Pharmacy
Primary
5306000370
MI
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Enumeration date
09/06/2005
Last updated
01/12/2012
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