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Organization

EXPRESS CARE MEDICAL SUPPLY INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. RITA ILYASOV (PRESIDENT)
(248) 451-0073
Entity
Organization

Contact information

Practice address
12 W HURON ST, PONTIAC, MI 48342-2100
(248) 451-0073
Mailing address
12 W HURON ST, PONTIAC, MI 48342-2100
(248) 451-0073

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
6612000001
MEDICARE PTAN
MI
Enumeration date
02/21/2011
Last updated
05/07/2014
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