Provider Demographics
NPI:1265328876
Name:ATHENA MEDICAL SUPPLIES, INC
Entity type:Organization
Organization Name:ATHENA MEDICAL SUPPLIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEEPTI
Authorized Official - Middle Name:
Authorized Official - Last Name:KALYANKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-399-4223
Mailing Address - Street 1:8424 E 12 MILE RD STE B4-1
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2700
Mailing Address - Country:US
Mailing Address - Phone:248-399-6569
Mailing Address - Fax:248-399-6749
Practice Address - Street 1:8424 E 12 MILE RD STE B4-1
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2700
Practice Address - Country:US
Practice Address - Phone:248-399-6569
Practice Address - Fax:248-399-6749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies