Provider Demographics
NPI:1245323823
Name:METRO MED CORPORATION
Entity type:Organization
Organization Name:METRO MED CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:VITALIY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRYTSYUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-495-5339
Mailing Address - Street 1:27224 SOUTHFIELD RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076
Mailing Address - Country:US
Mailing Address - Phone:248-443-0008
Mailing Address - Fax:248-232-1583
Practice Address - Street 1:27224 SOUTHFIELD RD
Practice Address - Street 2:SUITE 8
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076
Practice Address - Country:US
Practice Address - Phone:248-443-0008
Practice Address - Fax:248-232-1583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2007-07-27
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
MI4987654Medicaid
MI54-0-F3-3661-0OtherBLUE CROSS/BLUE SHIELD
MI4993640002Medicare NSC