Provider Demographics
NPI:1992986517
Name:STAR MEDICAL EQUIPMENT AND SUPPLIES
Entity type:Organization
Organization Name:STAR MEDICAL EQUIPMENT AND SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BERTRAM
Authorized Official - Middle Name:N
Authorized Official - Last Name:NWAOPARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-471-4669
Mailing Address - Street 1:34741 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48335-3315
Mailing Address - Country:US
Mailing Address - Phone:248-471-4669
Mailing Address - Fax:248-471-4899
Practice Address - Street 1:34741 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48335-3315
Practice Address - Country:US
Practice Address - Phone:248-471-4669
Practice Address - Fax:248-471-4899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4693619Medicaid
MI5398880001Medicare NSC