Provider Demographics
NPI:1962058917
Name:MA4L INC
Entity type:Organization
Organization Name:MA4L INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SLUKA
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:810-733-5300
Mailing Address - Street 1:1303 S LINDEN RD STE C
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3442
Mailing Address - Country:US
Mailing Address - Phone:810-733-5300
Mailing Address - Fax:810-733-5396
Practice Address - Street 1:1303 S LINDEN RD STE C
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3442
Practice Address - Country:US
Practice Address - Phone:810-733-5300
Practice Address - Fax:810-733-5396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1679928865Medicaid