Organization
INTIMATE ILLUSIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEAN ELMER SIMONE (PRESIDENT MASTECTOMY FITTER)
(906) 776-2190
Entity
Organization
Contact information
Practice address
333 S STEPHENSON AVE, IRON MOUNTAIN, MI 49801-2942
(906) 776-2190
(906) 776-2191
Mailing address
333 S STEPHENSON AVE, IRON MOUNTAIN, MI 49801-2942
(906) 776-2190
(906) 776-2191
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
04/12/2007
Last updated
03/27/2008
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