Provider Demographics
NPI:1447492780
Name:MEDLIFE DME, INC.
Entity type:Organization
Organization Name:MEDLIFE DME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MANIVANAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAGERSWAMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-994-0657
Mailing Address - Street 1:28423 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2971
Mailing Address - Country:US
Mailing Address - Phone:248-994-0657
Mailing Address - Fax:248-994-0658
Practice Address - Street 1:28423 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2971
Practice Address - Country:US
Practice Address - Phone:248-994-0657
Practice Address - Fax:248-994-0658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies