1750608477 NPI number — PROS-TECH, INC.

Table of content: (NPI 1750608477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750608477 NPI number — PROS-TECH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROS-TECH, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750608477
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1717 STEPHENSON HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48083-2149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-680-2800
Provider Business Mailing Address Fax Number:
248-680-2804

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13850 E 12 MILE RD
Provider Second Line Business Practice Location Address:
SUITE 2B
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48088-3730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-541-1040
Provider Business Practice Location Address Fax Number:
586-552-8310
Provider Enumeration Date:
04/21/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GIRARDOT
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-680-2800

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)